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How neurodivergent people can deal with task paralysis

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Strategies to promote executive functioning

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The level of instruction a neurodivergent brain needs to complete a task

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The level of instruction a neurodivergent brain needs to complete a task

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Briana Plyler || ADHD Coach on Instagram: "Feel overwhelmed often? 

This might be why. Our brains don’t always naturally break down tasks, much less prioritize them and put them in the correct order.

This might be way some days, everything feels like too much. 

Add to that our struggle to properly see time and any to do list can feel like a giant ball of tasks that must be completed right this second! 

It makes perfect sense that you would be overwhelmed. 

The next time you’re feeling overwhelmed, try this:

Take a minute to put all of the thoughts/tasks on paper or your phone

Once you can see it you can better manage it. 

One step at a time, friends! The journey continues ❤️

#adhdadult #adhdawareness #adhdcommunity"

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3,691 likes, 53 comments - currentadhdcoaching on January 6, 2023: "Feel overwhelmed often? 

This might be why. Our brains don’t always naturally break down tasks, much less prioritize them and put them in the correct order.

This might be way some days, everything feels like too much. 

Add to that our struggle to properly see time and any to do list can feel like a giant ball of tasks that must be completed right this second! 

It makes perfect sense that you would be overwhelmed. 

The next time you’re feeling overwhelmed, try this:

Take a minute to put all of the thoughts/tasks on paper or your phone

Once you can see it you can better manage it. 

One step at a time, friends! The journey continues ❤️

#adhdadult #adhdawareness #adhdcommunity". 

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View this post on Instagram

A post shared by Briana Plyler || ADHD Coach (@currentadhdcoaching)

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Published: 2010-09-10 - Updated: 2022-03-30
Author: Disabled World | Contact: Disabled World (Disabled-World.com)
Peer-Reviewed Publication: N/A
Jump to: Main Digest

Synopsis: Lists the scholarly defined different models of disability and also provides explanations on each of the various current models in society today. The spectrum model refers to the range of visibility, audibility and sensibility under which mankind functions. The model asserts that disability does not necessarily mean reduced spectrum of operations. Disability rights movements, activists, scholars, and practitioners construct debates around the two main models, social and medical, of understanding of disabilities.

Main Digest

Disability studies is an academic discipline that examines and theorizes about the social, political, cultural, and economic factors that define disability. The disability rights movement, scholars, activists and practitioners construct debates around two distinctly different models of understanding of disability - the social and medical models of disability.

Many scholars in disability studies describe a medical model of disability that is part of the general biomedical approach. In this model, disability is considered an entirely physical occurrence, and being disabled is a negative that can only be made better if the disability is cured and the person is made "normal". Many disability rights advocates reject this, and promote a social model in which disability is a difference - neither a good nor bad trait.

The Models of Disability

Biomedical Model of Health

The biomedical model of health is the most dominant in the western world and focuses on health purely in terms of biological factors. Contained within the biomedical model of health is a medical model of disability. In a similar vein, this focuses on disability purely in terms of the impairment that it gives the individual. The biomedical model is often contrasted with the biop-sychosocial model.

Clipart image of an empty wheelchair in the foreground with colored silhouettes of people to the left and right of the wheelchair. A world map is featured in the background.

Medical Model of Disability

The medical model of disability is presented as viewing disability as a problem of the person, directly caused by disease, trauma, or other health condition which therefore requires sustained medical care provided in the form of individual treatment by professionals.

In the medical model, management of the disability is aimed at a "cure," or the individual's adjustment and behavioral change that would lead to an "almost-cure" or effective cure.

In the medical model, medical care is viewed as the main issue, and at the political level, the principal response is that of modifying or reforming health-care policy.

Identity Model

Disability as an identity model is closely related to the social model of disability - yet with a fundamental difference in emphasis - is the identity model (or affirmation model) of disability.

This model shares the social model's understanding that the experience of disability is socially constructed, but differs to the extent that it 'claims disability as a positive identity' (Brewer et al. 2012:5). Brewer et al. (2012) offer the following illuminating definition, which also explains how the identity model departs from the social model's approach - (http://www.scielo.org.za/pdf/hts/v74n1/06.pdf)

Social Model of Disability

The social model of disability sees the issue of "disability" as a socially created problem and a matter of the full integration of individuals into society.

In this model, disability is not an attribute of an individual, but rather a complex collection of conditions, many of which are created by the social environment. Hence, the management of the problem requires social action and is the collective responsibility of society at large to make the environmental modifications necessary for the full participation of people with disabilities in all areas of social life.

The issue is both cultural and ideological, requiring individual, community, and large-scale social change. From this perspective, equal access for someone with an impairment/disability is a human rights issue of major concern.

Minority Model of Disability

The minority model of disability, also known as sociopolitical model of disability, adds to the social model, the idea that disability is imposed on top of impairment via negative attitudes and social barriers, in suggesting that people with disabilities constitute a entitative, (relating to or possessing material existence), social category that shares in common the experience of disability.

The minority model normalizes the experience of disability as a minority experience no more or less aberrant or deviant than other minority groups' experiences (sex, race, sexual orientation, etc.). Essentially, this is the assertion that people with disabilities are, in part, disabled not by what's going on with our bodies per se, but by the manner in which the able-bodied majority of society views us and either molds or does not mold itself to allow us to fit.

Expert or Professional Model of Disability

The expert or professional model of disability has provided a traditional response to disability issues and can be seen as an offshoot of the medical model.

Within its framework, professionals follow a process of identifying the impairment and its limitations (using the medical model), and taking the necessary action to improve the position of the disabled person. This has tended to produce a system in which an authoritarian, over-active service provider prescribes and acts for a passive client.

Tragedy and/or Charity Model of Disability

The tragedy and/or charity model of disability depicts disabled people as victims of circumstance who are deserving of pity.

This, along with the medical model, are the models most used by non-disabled people to define and explain disability.

Moral Model of Disability

The moral model of disability refers to the attitude that people are morally responsible for their own disability. For example, the disability may be seen as a result of bad actions of parents if congenital, or as a result of practicing witchcraft if not.

This attitude may also be viewed as a religious fundamentalist offshoot of the original animal roots of human beings when humans killed any baby that could not survive on its own in the wild. Echoes of this can be seen in the doctrine of karma in Indian religions.

Legitimacy Model of Disability

The legitimacy model of disability views disability as a value-based determination about which explanations for the atypical are legitimate for membership in the disability category. This viewpoint allows for multiple explanations and models to be considered as purposive and viable (DePoy & Gilson, 2004) (Elizabeth DePoy & Stephen Gilson).

Empowering Model of Disability

The empowering model of disability allows for the person with a disability and his/her family to decide the course of their treatment and what services they wish to benefit from. This, in turn, turns the professional into a service provider whose role is to offer guidance and carry out the client's decisions. In other words, this model "empowers" the individual to pursue his/her own goals.

Social Adapted Model of Disability

The social adapted model of disability states although a person's disability poses some limitations in an able-bodied society, oftentimes the surrounding society and environment are more limiting than the disability itself.

Economic Model of Disability

The economic model of disability defines disability by a person's inability to participate in work.

It also assesses the degree to which impairment affects an individual's productivity and the economic consequences for the individual, employer and the state. Such consequences include loss of earnings for and payment for assistance by the individual; lower profit margins for the employer; and state welfare payments. This model is directly related to the charity/tragedy model.

Diversity Model of Disability

Disability as Human Variation, an alternative model intended to focus attention on how society's systems respond to variation introduced by disability (Scotch and Shriner 1997). Under this model, accessibility in the built environment, for example, is not solely achieved by anti-discrimination regulation requiring a 'universal solution; the diversity of disability must be acknowledged (Scotch and Shriner 1997). Shriner and Scotch (2001) further question the socio-political definition of disability, in which (all) barriers faced by people with disability are (built-environment) imposed and therefore removable, feeling that this common underlying ideology of disability rights activists and independent living movements insufficiently recognizes that impairment does have a bearing on accessibility outcomes.

Seeking to overcome the false dichotomy of ability/disability, Bickenbach et al. (1999) pursue the concept of universalism, proposing: While the social model is now universally accepted, it is argued that universalism as a model for theory development, research and advocacy serves disabled persons more effectively than a civil rights or minority group approach. (p. 1173) - (Models of Disability and Human Rights: Informing the Improvement of Built Environment Accessibility for People with Disability at Neighborhood Scale?)

What Is: Neurodiversity, Neurodivergent, Neurotypical

Religious Model of Disability

The moral/religious model of disability is the oldest model of disability and is found in a number of religious traditions, including the Judeo-Christian tradition (Pardeck & Murphy 2012:xvii). The religious model of disability is a pre-modern paradigm that views disability as an act of a god, usually a punishment for some sin committed by the disabled individual or their family. In that sense, disability is punitive and tragic in nature.

This model frames disability as something to be ashamed of and insinuates that disabled people or their families are guilty of some unknown action that caused their impairment. But that mentality only serves to stigmatize disability, and the claim that praying heals disability is based on purely anecdotal evidence.

Disability and Religion: Studies and Overview

Market Model of Disability

The market model of disability is a minority rights and consumerist model of disability that recognizing people with disabilities and their Stakeholders as representing a large group of consumers, employees and voters. This model looks to personal identity to define disability and empowers people to chart their own destiny in everyday life, with a particular focus on economic empowerment.

By this model, based on US Census data, there are 1.2 billion people in the world who consider themselves to have a disability. An additional two billion people are considered Stakeholders in disability (family/friends/employers), and when combined to the number of people without disabilities, represents 53% of the population. This model states that, due to the size of the demographic, companies and governments will serve the desires, pushed by demand as the message becomes prevalent in the cultural mainstream.

Human Rights Based Model of Disability

From the mid 1980's countries such as Australia enacted legislation which embraced rights-based discourse rather than custodial discourse and seeks to address the issues of social justice and discrimination. The legislations embraced the shift from disability being seen as an individual medical problem to it instead being about community membership and fair access to social activities such as employment, education and recreation.

The emphasis in the 1980's shifted from dependence to independence as people with disabilities sought to have a political voice. Disability activism also helped to develop and pass legislation and entitlements became available to many people. However, while the rights-based model of disability has helped to develop additional entitlements, it has not changed the way in which the idea of disability is constructed. The stigma of 'bad genes' or 'abnormality' still goes unchallenged and the idea of community is still elusive - (https://sites.google.com/site/changesintheviewsofdisability/models-of-disability)

Relational Model of Disability

In the late 1960s Nirje, a Swedish social theorist, formulated the principles of normalization emphasizing strong support of de-institutionalization, recognition of the diversity of the human condition, and belief that people with disability and 'normal' (ordinary) life, including access to the built environment, are not mutually exclusive.

This work represents part of an emerging grand idea of social inclusion for people with disability in the community and within the neighborhood (Nirje [1969] 1994). Following on in this continuum of Nordic interest in people - environment interaction, a new disability model developed around the end of 1990s - early2000s, and has subsequently been recognized as the (Nordic) Relational Model of Disability (Goodley 2011) - (Models of Disability and Human Rights: Informing the Improvement of Built Environment Accessibility for People with Disability at Neighborhood Scale?)

Affirmation Model of Disability

The affirmation model of disability is essentially a non-tragic view of disability and impairment which encompasses positive social identities, both individual and collective, for disabled people grounded in the benefits of lifestyle and life experience of being impaired and disabled. This view has arisen in direct opposition to the dominant personal tragedy model of disability and impairment, and builds on the liberatory imperative of the social model.

Rooting their idea in the values of Disability Pride and perspectives emerging from the disability arts movement, Swain and French identified the affirmation model as a critique of the personal tragedy model corresponding to the social model as a critique of the medical model.

Spectrum Model of Disability

The spectrum model of disability refers to the range of visibility, audibility and sensibility under which mankind functions. The model asserts that disability does not necessarily mean reduced spectrum of operations.

International Classification of Functioning, Disability and Health (ICF)

The International Classification of Functioning, Disability and Health (ICF) is a framework for describing and organizing information on functioning and disability. It provides a standard language and a conceptual basis for the definition and measurement of health and disability.

Infographic outlining some of the Models of Disability classifications.

Also See:

Disabled World is an independent disability community established in 2004 to provide disability news and information to people with disabilities, seniors, their family and/or carers. See our homepage for informative news, reviews, sports, stories and how-tos. You can also connect with us on Twitter and Facebook or learn more about Disabled World on our about us page.

Disabled World provides general information only. The materials presented are never meant to substitute for professional medical care by a qualified practitioner, nor should they be construed as such. Financial support is derived from advertisements or referral programs, where indicated. Any 3rd party offering or advertising does not constitute an endorsement.

Cite This Page (APA): Disabled World. (2010, September 10). Models of Disability: Types and Definitions. Disabled World. Retrieved September 12, 2022 from www.disabled-world.com/definitions/disability-models.php

* Permalink: <a href="https://www.disabled-world.com/definitions/disability-models.php">Models of Disability: Types and Definitions</a>

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Models of Disability: Types and Definitions

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Published: 2010-09-10 - Updated: 2022-03-30Author: Disabled World | Contact: Disabled World (Disabled-World.com)Peer-Reviewed Publication: N/AJump to: Main Digest Synopsis: Lists the scholarly defined different models of disability and also provides explanations on each of the various current models in society today. The spectrum model refers to the range of visibility, audibility and sensibility under which mankind functions.

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Alice ♡ The Mini ADHD Coach on Instagram: "How many spoons do you have left today 👀?

Many people are dealing with ADHD and Chronic Fatigue Syndrome, and it's a daily challenge to balance energy levels ☀️⛈️

Remember, it's okay to take a break and recharge 🤗

Your mental and physical health comes first 💕! 

If you want to learn about ADHD and CFS check out the last article on my website. It’s been written by Tayler Hackett (@inour_potentia), a Trainee Therapist, professional mental health writer and ADHD expert 😎

Her personal journey through ADHD and Chronic Fatigue Syndrome (CFS) is very insightful 🙌✨

#SpoonTheory #ADHDAwareness #ChronicFatigue"

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25K likes, 196 comments - the_mini_adhd_coach on November 15, 2023: "How many spoons do you have left today 👀?

Many people are dealing with ADHD and Chronic Fatigue Syndrome, and it's a daily challenge to balance energy levels ☀️⛈️

Remember, it's okay to take a break and recharge 🤗

Your mental and physical health comes first 💕! 

If you want to learn about ADHD and CFS check out the last article on my website. It’s been written by Tayler Hackett (@inour_potentia), a Trainee Therapist, professional mental health writer and ADHD expert 😎

Her personal journey through ADHD and Chronic Fatigue Syndrome (CFS) is very insightful 🙌✨

#SpoonTheory #ADHDAwareness #ChronicFatigue". 

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A post shared by Alice ♡ The Mini ADHD Coach (@the_mini_adhd_coach)

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Jami Fregeau | ADHD Life Strategies & Education on Instagram: "Types of ADHD Fatigue we don't talk about:

🙇‍♀️ Helper fatigue
🙇‍♀️ Depression fatigue
🙇‍♀️ Future fatigue
🙇‍♀️ Anxiety fatigue
🙇‍♀️ Compassion fatigue 

Aside from fatigue missing small typos is clearly an ADHD trait as well. 🙃

Which of these do you struggle with?

#ADHDfatigue
#ADHDCommunity
#ADHDTips
#ADHDLife
#ADHDSupport
#ADHDEducation
#ADHDManagement
#MentalHealthAwareness
#ADHDHelp
#ADHDAwareness
#ADHDResources
#AdultADHD
#ADHDStruggles
#ADHDStrategies
#ImpulsivityControl
#ExecutiveFunction
#FocusAndAttention
#TimeManagement
#ADHDJourney
#ADHDMotivation"

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4,999 likes, 277 comments - theneurodivergentnurse on July 4, 2024: "Types of ADHD Fatigue we don't talk about:

🙇‍♀️ Helper fatigue
🙇‍♀️ Depression fatigue
🙇‍♀️ Future fatigue
🙇‍♀️ Anxiety fatigue
🙇‍♀️ Compassion fatigue 

Aside from fatigue missing small typos is clearly an ADHD trait as well. 🙃

Which of these do you struggle with?

#ADHDfatigue
#ADHDCommunity
#ADHDTips
#ADHDLife
#ADHDSupport
#ADHDEducation
#ADHDManagement
#MentalHealthAwareness
#ADHDHelp
#ADHDAwareness
#ADHDResources
#AdultADHD
#ADHDStruggles
#ADHDStrategies
#ImpulsivityControl
#ExecutiveFunction
#FocusAndAttention
#TimeManagement
#ADHDJourney
#ADHDMotivation". 

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Why ADHDers are susceptible to overwhelm

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Why ADHDers are susceptible to overwhelm

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Meredith Carder | ADHD Coach on Instagram: "Our intense emotions, our fast moving thoughts, the fact that things that are easy for others can be so hard for us….it’s all overwhelming. 

What do you find most overwhelming as an ADHDer? Comment below and let us know what helps. ⬇️

Understanding how ADHD can contribute to overwhelm is critical to creating strategies to manage it. I dedicate an entire chapter to this topic in my book “It All Makes Sense Now” releasing in August. Available now for pre-order. 

#adhd #adhdsupport #overwhelm #adultadhd #adhdwomen #adhdmen #adhdparenting #adhdcommunity #adhdparalysis"

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1,586 likes, 5 comments - hummingbird_adhd on July 23, 2024: "Our intense emotions, our fast moving thoughts, the fact that things that are easy for others can be so hard for us….it’s all overwhelming. 

What do you find most overwhelming as an ADHDer? Comment below and let us know what helps. ⬇️

Understanding how ADHD can contribute to overwhelm is critical to creating strategies to manage it. I dedicate an entire chapter to this topic in my book “It All Makes Sense Now” releasing in August. Available now for pre-order. 

#adhd #adhdsupport #overwhelm #adultadhd #adhdwomen #adhdmen #adhdparenting #adhdcommunity #adhdparalysis". 

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Trevor Noah shares what living with ADHD feels like

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Trevor Noah shares what living with ADHD feels like

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Re:Set | Employee Well-Being on Instagram: "Comedian Trevor Noah recently opened up about how ADHD manifests for him. 

It requires a strict routine to help him manage the symptoms of ADHD. 

How do you manage it?

🎥: YouTube/60 Minutes 

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[Tags: #neurodiversityweek #neurodiversity #neurodiversity#trevornoah #adhd #adhdawareness ]"

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207K likes, 2,612 comments - resetyoureveryday on March 21, 2024: "Comedian Trevor Noah recently opened up about how ADHD manifests for him. 

It requires a strict routine to help him manage the symptoms of ADHD. 

How do you manage it?

🎥: YouTube/60 Minutes 

.
.
.
[Tags: #neurodiversityweek #neurodiversity #neurodiversity#trevornoah #adhd #adhdawareness ]". 

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Why Is ADHD So Impairing? By Dr. Russell Barkley, Ph.D.

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Why Is ADHD So Impairing? By Dr. Russell Barkley, Ph.D.

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Russell Barkley, PhD - Dedicated to ADHD Science+

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Jo Muir | The ADHD Collective 💙 on Instagram: "Many of our #adhd community wear masks daily....

A mask, can build the illusion that a person does not struggle with the task at hand or the situation they find themselves in.

Many children wear a mask during school time and once home, become their own selves again. 

These can create a sense of security and acceptance for that person, not feeling that they are any different. 

These are not bad traits at all. They allow many of us to cope. 

As always, be kind 💙

#ouradhdjourney #adhdcommunity #adhdreallife #adhdtraits #adhdmindset #adhdaustralia #adhdcollective #adhdtruth #adhdlife #adhdsupport #adhdexplained #adhdstrategies #adhdwomen #adhdkids #adhdawareness #adhdadventures #adhdcoach #bekind #adhdhints #attentiondeficithyperactivitydisorder #adhdchallenges #adhdbackpack #adhdhacks"

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42K likes, 43 comments - the_adhd_collective_ on November 3, 2022: "Many of our #adhd community wear masks daily....

A mask, can build the illusion that a person does not struggle with the task at hand or the situation they find themselves in.

Many children wear a mask during school time and once home, become their own selves again. 

These can create a sense of security and acceptance for that person, not feeling that they are any different. 

These are not bad traits at all. They allow many of us to cope. 

As always, be kind 💙

#ouradhdjourney #adhdcommunity #adhdreallife #adhdtraits #adhdmindset #adhdaustralia #adhdcollective #adhdtruth #adhdlife #adhdsupport #adhdexplained #adhdstrategies #adhdwomen #adhdkids #adhdawareness #adhdadventures #adhdcoach #bekind #adhdhints #attentiondeficithyperactivitydisorder #adhdchallenges #adhdbackpack #adhdhacks". 

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6 Ways to Manage Rejection Sensitive Dysphoria | Self-Love Rainbow

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When I first read about Rejection Sensitive Dysphoria I was like “Wow. That’s exactly what I experienced.” There’s still a lot of research being done about RSD* and while it is not something that you can be diagnosed with, it is a way to describe symptoms and it resonates with a lot of people -

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Masking in attention deficit hyperactivity disorder (ADHD) refers to the conscious or subconscious efforts of individuals to hide or suppress their symptoms in order to conform to social expectations or avoid negative judgments and stigmatization.

This form of behavioral modification can also be referred to as "impression management" and is usually done in an attempt to overcompensate or camouflage one's ADHD tendencies (Barkley, 2020).

ADHD masking Examples

There are many ways in which ADHD symptoms can be masked. Below are some examples:

Hiding your true feelings and presenting behaviors that would be more neurotypical instead

Trying to suppress certain soothing behaviors, such as stimming (self-stimulating behavior)

Masking the fact that you worry about criticism and negative feedback by portraying a more nonchalant persona

Developing the need to obsessively check over things, e.g., your personal possessions

Being overly apologetic to hide tendencies of forgetfulness or lack of focus

Remaining silent or withdrawn in social situations out of worry of judgments over ADHD symptomatology

Striving for perfectionism at most things you do

Taking on too much in order to showcase your capability and override any emotions of not being good enough

Expending a lot of energy actively listening to ensure you do not miss any social cues or what is being said

Masking any emotions such as fatigue, anxiety, or self-doubt

"I used to literally bite my lip to stop interrupting and until it bled."
Dr Alex Conner

Individuals with ADHD may learn to mask their symptoms, especially if they have not been diagnosed and treated.

This can make it even harder for clinicians to identify ADHD, as the individual may appear to be anxious or shy rather than displaying typical ADHD symptoms.

This can be further exacerbated in girls and women as they often go underdiagnosed or misdiagnosed (Lai, Lin & Ameis, 2022).

Racial and ethnic minority groups are also more likely to mask due to the additional factor of discrimination they may face, reducing the likelihood of early detection and diagnosis.

"I've lost a little bit of my own ethnic culture and my own foundations... I'm South Asian and Pakistani. I've lost a little bit of that ... to try and become something I'm not."
Sonya Barlow, Author (2023)

What ADHD Symptoms are Masked?

There are countless ways in which ADHD can be expressed and explained, so some people may mask some symptoms but not others. That being said, there are some more common behaviors frequently associated with impression management.

One such example is impulsive behavior. This could range from frequently holding back the urge to interrupt or react quickly without much thought.

Another behavior frequently masked is inattention. This could range from forcing yourself to concentrate when someone is talking to mimicking body language to show you are actively listening to what is being said.

Also, hyperactivity and self-regulatory behaviors such as stimming are often attempted to be camouflaged in social situations.

This could look like forcing yourself to sit still and not fidget or restricting body language, e.g., crossing arms or legs to avoid squirming.

Do neurotypicals mask?

Neurotypical people can indeed mask as well. Various situations could arise, which can then prompt them to adopt their own versions of a "persona" to help them navigate situations and feel that they need to camouflage how they would really act or react, respectively.

The desire to be accepted and fit in with peers is one such primary case shared amongst most people, regardless if they are neurotypical or neurodivergent. Masking can help support this, but the reasoning behind it differs.

Masking ADHD can help people feel like they are behaving in more neurotypical ways (Jorgenson, Lewis, Rose & Kanne, 2020), while for neurotypicals, it can help mask any behaviors perceived as less socially desirable, e.g., being more introverted.

Additionally, this camouflaging can also happen in professional and work environments, for example, during a presentation to hide nerves or during a job interview where they want to be portrayed a certain way.

Lastly, masking may arise in neurotypical individuals who may be struggling with their mental health, e.g., depressionor anxiety.

For example, they may try to portray a more confident version of themselves to hide their social anxiety or put on a smile to hide their low mood.

Why do People with ADHD Mask?

There are several reasons why people with ADHD mask, and it can differ from person to person. However, there are some common underlying motivational factors that often drive the desire to mask (Sarenius, 2022).

Desire to belong

One such reason is the desire to belong and societal pressures. The majority of people crave social connections and want to fit in with their peers and society as a whole.

Masking ADHD can help people feel like they are behaving in more neurotypical ways, which can, in turn, reduce perceived notions of being an outsider or feelings of unwantedness.

"I always felt like I had to perform in order for people to understand my intentions, which I think is a feeling that a lot of us can relate to with masking. Like, let me go above and beyond to show that I can be responsible and kind and pleasing and obedient... because you need approval."
René Brooks, Educator

Fear of being socially rejected

Following on from this, another reason for ADHD masking linking to the previous point is fear of stigmatization and bullying.

A few ADHD behaviors, such as impulsivity, may not be very accepted in social situations, so masking and suppressing such urges can act as a protective mechanism against potential judgment or criticism.

Being neurotypical is 'favored'

Neurotypical behavior is usually favored in most societies and cultures, further deriving the need to camouflage neurodivergent tendencies and reactions.

For example, in the workplace, it may be seen as better to be focused and attentive rather than unfocused and inattentive, which are some of the primary ADHD symptoms.

Such behaviors may be restricted or scolded starting from a young age. Children displaying neurodivergent or ADHD behavior, such as lack of concentration or impulsiveness, e.g., shouting out answers in class, may be chastised by teachers or ostracized by fellow students and peers.

The notion that it is unfavorable to act in such ways can thus push people to begin masking who they are instead of being their authentic self.

Why Can Masking be a Problem?

Masking, while certainly offering several benefits to individuals with ADHD, can turn problematic when activated too frequently and for long spouts of time.

There are still several societal situations, cultural, ethnic, and religious structures, and daily instances where people on the neurodiversity spectrum may feel unsafe or uncomfortable being themselves.

Hiding their ADHD symptoms can thus become a default mode (even activated unconsciously if relied on and engaged in frequently), leading to several potential problems.

Such issues can manifest either in isolation or usually in various combinations due to the intricate interconnectedness between them.

Consequently, and more often than not, one issue can lead to another, generating an array of problems.

Let us now discuss some of the most common issues that may arise from masking.

Burnouts

Constant self-monitoring of emotions and behaviors can naturally become absolutely exhausting due to the heavy censorship and cognitive energy masking requires.

The worry, anxiety, and other related symptoms that can arise when camouflaging add to this mental load, further exacerbating the situation.

Consequently, this can lead to feelings of fatigue and burnout, with the body not being able to cope with the stress it is being put under.

"I tried to mask and I try to mask maybe so hard that I didn't realize I was masking and then eventually I got exhausted from masking because it hurts your brain and it makes you feel tired."
Sonya Barlow, Author (2023)

Decreased self-esteem

Masking can lead to a sense of disconnect between who you are and your wish to be authentic vs. the version of yourself that you portray when engaging in masking behavior.

This frequent hiding of your genuine self can begin to take a toll and massively plummet positive self-perceptions.

With time, this can lead to a reduction of self-esteem, confidence, and unhelpful thought patterns, significantly increasing the chances of mental health struggles such as depression as well (Sowislo & Orth, 2013).

"I've got really low self-esteem, and I think I'm [ __ ] at everything, and I don't want people to know how [ __ ] I am, so I think I do my best to hide it."
Sam Brown

Low sense of self

Linking to a decreased self-esteem due to the dissociation of the authentic you and masked you, a low sense of self can begin to develop.

Feelings of inadequacy and hyper-focusing on just the negative can begin to arise due to the different masks people have to remember to wear depending on the person/occasion, potentially making them further overwhelmed and unsure of which version of themselves to be.

Consequently, this can generate feelings of loss and confusion over what your true identity is and further agitate negative self-perceptions and judgments.

Can be distracting

Distraction is something many people with ADHD battle with, and it can become exacerbated with masking as a byproduct of the cognitive demand it takes on one's mental load.

Instead of being able to be fully present, available, and focused in social situations, there are thoughts around censorship and behavioral management constantly circulating.

It can thus increase the prominence of loss of focus and overall contribute to reduced productivity.

Increased anxiety

Feeling that your true identity may not be accepted, respected, or cared for in specific social settings, and as a result, you need to mask and hide part of yourself, can ultimately lead to increased anxiety.

The constant worry of not wishing others to recognize or see you struggling can also contribute to this. Lastly, being stressed when going out or not enjoying your time are common adjacent symptoms.

Imposter syndrome

Imposter syndrome describes when someone feels like their achievements and successes have not been rightfully earned despite any clear evidence proving otherwise.

This sense of self-fraud may arise from masking again due to the disconnect between one's real self and the persona they adopt in social settings. As a result, this can prevent people from being present and enjoying their time interacting with others.

Late diagnosis

Effectively masking your symptoms can make it harder for others to notice that you have any difficulties and offer the correct avenues for care and support.

This can make it less likely that you will be referred for an early diagnosis, further exacerbating pockets where you are left dealing with symptoms alone.

Late diagnosis is thus more likely ( especially for women), which can make it harder for someone to re-learn maladaptive behaviors they have been engaging in and relying on for years.

Depressed feelings

Due to the previously outlined reasons, all this emotional turmoil, anxiety, and identity disconnect can really take a harsh toll on someone's psyche.

Feelings of extreme sadness, low moods, and bouts of depression can then arise, potentially further isolating someone.

This can also heighten the need to camouflage, creating a vicious cycle of masking symptoms whose etiology stems from said masking itself (Meinzer et al., 2013; Quinn & Madhoo, 2014).

Substance abuse

Lastly, and linking with the previous points, all of these overwhelmingemotions can become unmanageable and lead someone down the path of substance abuse, e.g., alcohol or drugs, in an attempt to cope with the situation.

This can lead to a whole other array of additional symptoms and situations needing further masking, creating another potential vicious cycle of dependency.

Such substance abuse can develop into a further form of masking, hiding ADHD symptomatology (Katzman, Bilkey, Chokka, Fallu & Klassen, (2017)

Can Masking be Beneficial?

Masking can certainly be beneficial for individuals with ADHD and can act as a behavioral mechanism aimed at guiding people in navigating day-to-day life and social expectations.

The main benefits of masking rely on a sense of belonging and "fitting in" with the rest of one's peers, social groups, and overall society as a whole.

This can range from outings with friends to even more career-oriented situations and professional settings, such as helping you get a job.

By masking any ADHD reactions and symptomatology, people may feel safer and develop a higher sense of confidence, in turn, feeling more accepted by the world around them.

Masking may also be beneficial in reducing forms of social stigmatization and exclusion. Fears of being discriminated against or even bullied can often plague people with ADHD.

Through masking, any potential negative attention can be reduced and help people feel safer and create a sense of "blending in."

It is important to note that despite having certain benefits, excessively engaging and relying on masking can start having the opposite of any desired effects.

Balance is key to avoiding severe side effects such as burnout and deconstruction of a sense of self.

Masking vs Mirroring

Masking and mirroring are two forms of behavior often associated with ADHD and overall neurodivergent behavioral adjustments in general.

While both are forms of modification in an attempt to better align with current perceived societal norms and avoid negative judgment, their underlying mechanisms and reasonings behind engaging in them differ.

For masking, its primary function is assimilating with one's environment and societal expectations by hiding or suppressing one's ADHD symptoms.

This could look like hiding behaviors such as impulsivity, lack of focus, and heightened reactivity by suppressing, avoiding, or deflecting emotions and other related tendencies.

For mirroring, its primary function is assimilating with one's environment and societal expectations by "copying" what others are doing.

This could look like mirroring behaviors such as facial expressions (e.g., smiling), eye contact, and overall body language.

How to Deal with Masking

Masking, while beneficial in some situations, can lead to various challenges for individuals with ADHD. As ADHD presents uniquely in each person, coping strategies like masking become an important aspect of their lives that require attention and understanding.

Supporting individuals with ADHD in their neurodiversity journey is crucial, ensuring they have access to resources and support that allow them to express themselves authentically. Managing masking behaviors is essential for people with ADHD of all ages and genders.

Friends, family, and allies play a vital role in creating a welcoming and inclusive environment for those with ADHD. Educating oneself about ADHD and masking is an excellent first step in providing support.

There are several ways to approach masking, and it's important to find strategies that promote self-acceptance and celebrate neurodiversity.

Let's explore some common methods for navigating masking in a way that empowers individuals with ADHD.

Get treatment and a diagnosis

Ensuring you have access to the proper treatment and diagnosis is key when dealing with masking and overall ADHD symptomatology.

This can help ensure the information and care you are receiving will be the most appropriate and tailored to your individual needs and ADHD-expressed behaviors.

It is often recommended to reach out and engage with your nearest and most accessible mental health professional to get the appropriate support and guidance.

Identify the masking behaviors

Recognizing masking behaviors linked with ADHD is the first step in dealing with and coping with impression management symptoms.

Is there a difference in how you behave at home in your own company compared to social situations? Do you feel the need to mask who you are with certain people and not others?

These are some questions you may begin thinking over. By identifying masking behaviors for what they are and reflecting on under which circumstances you seem to be engaging in them, you will further understand your neurodiverse traits better.

Separate healthy and unhealthy behaviors

Not all masking behavior is unhealthy, but not all masking behavior is healthy, either.

Each person is unique in their situation, life, needs, environmental factors, etc., and how ADHD connects with all these variables.

Self-reflect on your actions, identify which masking behaviors are not helping you live your authentic life, e.g., hiding if you are stressed or masking your need to fidget, and begin separating between what is helping you progress or potentially worsening the situation.

"I am continuing to learn what does and doesn't work for me regarding medication and behavior modification. It's a journey and sometimes, quite frankly, it's a pain in the butt. But it's so worth it."
'Ellen' diagnosed with ADHD in her 50s.

Work on emotional regulation

Emotional dysregulation and inability to control feelings can be the underlying cause leading to masking for many.

Masking is not the only way or solution that can be utilized to help support someone in social situations. By working on alternative emotional regulation strategies and healthy coping mechanisms, you can reduce your need for masking and begin a positive journey moving forward using additional methodologies.

Some examples of alternatives are mindfulness, journaling, and engaging in therapy.

Celebrate your strengths and neurodiversity

Celebrating neurodiversity and recognizing the unique strengths of individuals with ADHD is crucial for creating a more inclusive society.

By embracing ADHD identity and challenging stereotypes, we can work towards a world where people with ADHD feel empowered to be their authentic selves without the need to mask.

It's important to celebrate your own strengths and achievements, giving yourself the self-love and acceptance you deserve. Educate yourself and others about ADHD, challenge biases, and advocate for policies that support the inclusion and empowerment of individuals with ADHD in all aspects of society.

By promoting a diverse understanding of ADHD and creating a more accepting world, we can reduce the pressure to mask and allow individuals with ADHD to thrive as their authentic selves.

"I'm not trying to wear a mask and you know what there's seven billion people in the world so if they don't like you somebody will eventually."
Sonya Barlow, Author (2023)

Consider dropping the mask

If you feel like you are in a safe environment to do so, it might be worth considering dropping the mask.

"The only people I unmasked around were either real friends or real friends who I know also have ADHD. I have plenty of acquaintance-level people I won't unmask (or at least do my best not to) around & unsafe people including members of my own family."
'Rita'

Allowing yourself to both feel and express your emotions and behaviors freely and authentically can help reduce feelings of anxiety, imposter syndrome, and burnout.

"One example for me was hanging out with friends without having something to do while we talk. My friends now know that I listen better if I'm knitting or stitching or even playing a simple game on my phone. So if they see me doing that, they don't immediately assume I'm "checking out" of the conversation. When I was masking, I felt like I had to keep "normal" amounts of eye contact, and it was miserable and exhausting. It made me not want to be around people at all."
'Harriet'

How to Start Unmasking

Beginning the process of unmasking ADHD can be challenging, particularly for those who have been masking their symptoms for a significant portion of their lives.

Dropping the ADHD mask is not as simple as flipping a switch. It's important to remember that masking is a behavior that has been learned and reinforced over time for many individuals with ADHD. Unmasking is a gradual process that requires time and patience.

Here is a step-by-step guide to help you start your ADHD unmasking journey:

1. Reflect on your ADHD masking behaviors: Take time to identify the specific ways in which you mask your ADHD symptoms, such as suppressing fidgeting, forcing yourself to focus on tasks that don't interest you, or scripting social interactions.

2. Identify safe spaces and people: Begin by finding supportive environments and relationships where you feel comfortable being your authentic self. It may be best to start with a trusted friend or family member who understands and accepts your ADHD.

3. Set small goals: Start by setting small, achievable goals for unmasking your ADHD, such as allowing yourself to take breaks when needed, openly discussing your ADHD with a trusted friend, or engaging in activities that align with your interests and strengths.

4. Reflect on what happened: After each situation where you practice unmasking, consider how it went. Did the other person respond positively? Did they notice or appreciate your authenticity?

5. Gradually increase unmasking: As you become more comfortable, gradually increase your ADHD unmasking behaviors in different settings and with more people. Remember to go at your own pace and prioritize your well-being.

6. Practice self-compassion: Unmasking ADHD can be emotionally challenging, so it's crucial to practice self-compassion and be kind to yourself throughout the process. Celebrate your progress and recognize that setbacks are a normal part of the journey.

7. Seek support: Don't hesitate to seek support from friends, family, therapists, or ADHD support groups as you navigate the unmasking process. Remember that you are not alone, and there are many people who understand and appreciate the unique strengths and challenges of ADHD.

It is crucial to remember that unmasking is a personal journey and may look different for everyone. Some individuals may choose to unmask in certain settings or with specific people, while others may feel comfortable unmasking more broadly. The key is to find a balance that feels safe and authentic to the individual.

Frequently Asked Questions

References

Barkley, R. A. (2020). Taking charge of ADHD: The complete, authoritative guide for parents. Guilford Publications.

Barlow, S. (Presenter). (2023, July 25). BBC Presenter: I'm Finally Being My Authentic Self - Sonya Barlow [Video]. https://www.youtube.com/watch?v=6AdH54tniiY

Chung, W., Jiang, S. F., Paksarian, D., Nikolaidis, A., Castellanos, F. X., Merikangas, K. R., & Milham, M. P. (2019). Trends in the prevalence and incidence of attention-deficit/hyperactivity disorder among adults and children of different racial and ethnic groups. JAMA network open, 2(11), e1914344-e1914344.

Jorgenson, C., Lewis, T., Rose, C., & Kanne, S. (2020). Social camouflaging in autistic and neurotypical adolescents: A pilot study of differences by sex and diagnosis. Journal of Autism and Developmental Disorders, 50, 4344-4355.

Katzman, 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, 1-15.

Lai, M. C., Lin, H. Y., & Ameis, S. H. (2022). Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders. Current Opinion in Psychiatry, 35(2), 90-100.

Meinzer, M. C., Lewinsohn, P. M., Pettit, J. W., Seeley, J. R., Gau, J. M., Chronis‐Tuscano, A., & Waxmonsky, J. G. (2013). Attention-deficit/hyperactivity disorder in adolescence predicts onset of major depressive disorder through early adulthood. Depression and Anxiety, 30(6), 546-553.

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16(3), 27250.

Sarenius, A. (2022). Masking: The Constant State of Seeking and Becoming.

Schatz, D. B., & Rostain, A. L. (2006). ADHD with comorbid anxiety: a review of the current literature. Journal of Attention disorders, 10(2), 141-149.

Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological bulletin, 139(1), 213.

Taurines, R., Schwenck, C., Westerwald, E., Sachse, M., Siniatchkin, M., & Freitag, C. (2012). ADHD and autism: differential diagnosis or overlapping traits? A selective review. ADHD Attention Deficit and Hyperactivity Disorders, 4, 115-139.

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Grace Koelma  •  Future ADHD on Instagram: "Have you ever found yourself sitting in the car for a few minutes before you go inside? 🚗

This is because ADHD brains 🧠 often have a more difficult time switching between tasks. It's not always as simple as Task A ➡ Task B 🤯

❤ Whats one strategy that helps you task switch? Comment below! 👇

📝 Our science-based, guilt-free ADHD Planner is used by 60k+ neurodivergents worldwide & recommended by therapists and psychologists. It has lifetime updates and it's subscription free (so it doesn't contribute to #ADHDtax) Check it out - link in bio! ✨

#taskswitching #adultadhd #adhdexperiences #adhdmind #neurodiversity #adhdmotivation #adhdresources #livingwithadhd #adhdcommunity #adhdwoman #adhdlife #adhdexplained #adhdeducation #adhdbrain #adhdwomen"

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2,564 likes, 31 comments - future.adhd on January 26, 2024: "Have you ever found yourself sitting in the car for a few minutes before you go inside? 🚗

This is because ADHD brains 🧠 often have a more difficult time switching between tasks. It's not always as simple as Task A ➡ Task B 🤯

❤ Whats one strategy that helps you task switch? Comment below! 👇

📝 Our science-based, guilt-free ADHD Planner is used by 60k+ neurodivergents worldwide & recommended by therapists and psychologists. It has lifetime updates and it's subscription free (so it doesn't contribute to #ADHDtax) Check it out - link in bio! ✨

#taskswitching #adultadhd #adhdexperiences #adhdmind #neurodiversity #adhdmotivation #adhdresources #livingwithadhd #adhdcommunity #adhdwoman #adhdlife #adhdexplained #adhdeducation #adhdbrain #adhdwomen". 

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Nikki 🍃 Life with chronic illness on Instagram: "This is a post full to the brim with info - i have included a lot - but brain fog 😶‍🌫️ is complex and so individual! 

I have lived with brain fog for years and years... its hard, so hard and we can feel like we are losing ourselves. To start to heal I had to accept what was happening, to trust it would get better and to try different things to help. 

This post is not a magical cure, its small ways to look after one of the most important aspects in our lives, our brains! 

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- have I got more on than I can handle?
- what can I try right now to help myself feel a bit better?
- have I made sure my basic needs are met? sleep, hydration, good food, rest, movement?
- do I need support?
- do I need to go and have my bloods checked in case I have deficiencies?

if you can, take time to pause to help you:
🍃stay in control
🍃process your emotions
🍃have space to allow your brain to settle

This is a mini toolkit based on evidence, but is not all inclusive. Take what interests you and leave the rest. Please seek support from a professional if you are not sure why you have brain fog as its a sign that things are not quite right in your body at the moment. 

⁣
.⁣
.⁣
.⁣
.⁣
.⁣
#antifatigue #anxiety #autoimmunedisease #brainfog #brainfogs #brainfogsucks #brainhealth #butyoudontlooksick #cfs #chronicfatiguesyndrome #chronicillness #chronicillnesswarrior #chronicpain #chronicpainwarrior #depression #fatigue #fatigued #fibromyalgia #healing #hormones #invisibleillness #lupus #lymedisease #meditation #mentalhealth #mentalhealthmatters #mentalwellness #pain #spoonie 

Thanks to the brilliant @lizandmollie @quotedvisually @chronicallymeh for their infographics ♥️"

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6,487 likes, 153 comments - giftofcalm on September 18, 2022: "This is a post full to the brim with info - i have included a lot - but brain fog 😶‍🌫️ is complex and so individual! 

I have lived with brain fog for years and years... its hard, so hard and we can feel like we are losing ourselves. To start to heal I had to accept what was happening, to trust it would get better and to try different things to help. 

This post is not a magical cure, its small ways to look after one of the most important aspects in our lives, our brains! 

When brain fog becomes difficult, maybe ask yourself:

- have I got more on than I can handle?
- what can I try right now to help myself feel a bit better?
- have I made sure my basic needs are met? sleep, hydration, good food, rest, movement?
- do I need support?
- do I need to go and have my bloods checked in case I have deficiencies?

if you can, take time to pause to help you:
🍃stay in control
🍃process your emotions
🍃have space to allow your brain to settle

This is a mini toolkit based on evidence, but is not all inclusive. Take what interests you and leave the rest. Please seek support from a professional if you are not sure why you have brain fog as its a sign that things are not quite right in your body at the moment. 

⁣
.⁣
.⁣
.⁣
.⁣
.⁣
#antifatigue #anxiety #autoimmunedisease #brainfog #brainfogs #brainfogsucks #brainhealth #butyoudontlooksick #cfs #chronicfatiguesyndrome #chronicillness #chronicillnesswarrior #chronicpain #chronicpainwarrior #depression #fatigue #fatigued #fibromyalgia #healing #hormones #invisibleillness #lupus #lymedisease #meditation #mentalhealth #mentalhealthmatters #mentalwellness #pain #spoonie 

Thanks to the brilliant @lizandmollie @quotedvisually @chronicallymeh for their infographics ♥️". 

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RBFB (Repetitive Body-Focused Behavior) as Stimming

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# data[].attributes.attachment_link.title
The Adhd Friend on Instagram: "I find that there are so many tips circulating out there for ADHD that almost seem as if they’re not made for ADHD brains at all.

Tips like:

Getting a planner - will probably just disappear in a drawer somewhere

Exercise regularly - although exercise is great for the ADHD brain, finding a way to do it consistently is very hard (but possible)

Keep a clutter free environment - yes it helps, but it’s not the clutter that really needs fixing, it’s the inability to be consistent with cleaning that’s actually the problem

So when I found this metaphor and actually tried implementing it into my day to day, oh boy did it actually make a difference. Because it was made with how my brain works in mind!

Turns out that alot of the chores we’ve been taught how to do in our everyday, have actually been made to work for the neurotypical brain. 

Unlearning them is hard, especially if some ways you prefer to do things are seen as ’’lazy’’ or ’’messy’’ by neurotypical standards (like using frozen veggies or not folding your laundry). But it is possible! 

Because if it stands between me actually feeding myself daily or me forcing myself to always use fresh vegetables - I prefer feeding myself.

READ: My posts are based on my experiences as a person diagnosed with ADHD and/or relatable stories from other people diagnosed with ADHD. I’m not a medical professional and I might get facts wrong, even though I try not to. Don’t use these as a diagnostic tool. Many people, ADHD or not, can experience alot of similar things based on different circumstances. 
If you suspect that you have ADHD please research from trustworthy sources and talk to a therapist that you trust about it! 🌸

#adhd #mentalhealth #anxiety #adhdawareness #adhdawarenessmonth #adhdcelebrationweek #adhdproblems #depression #awareness #adhdlife #mentalhealthawareness #neurodiversity #adhdsupport #adhdparenting #adhdbrain #neurodivergent #parenting #adhdmemes #adhdwomen #adhdgirls #love #adultadhd #adhdmom"

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19K likes, 393 comments - the.adhd.friend on June 20, 2024: "I find that there are so many tips circulating out there for ADHD that almost seem as if they’re not made for ADHD brains at all.

Tips like:

Getting a planner - will probably just disappear in a drawer somewhere

Exercise regularly - although exercise is great for the ADHD brain, finding a way to do it consistently is very hard (but possible)

Keep a clutter free environment - yes it helps, but it’s not the clutter that really needs fixing, it’s the inability to be consistent with cleaning that’s actually the problem

So when I found this metaphor and actually tried implementing it into my day to day, oh boy did it actually make a difference. Because it was made with how my brain works in mind!

Turns out that alot of the chores we’ve been taught how to do in our everyday, have actually been made to work for the neurotypical brain. 

Unlearning them is hard, especially if some ways you prefer to do things are seen as ’’lazy’’ or ’’messy’’ by neurotypical standards (like using frozen veggies or not folding your laundry). But it is possible! 

Because if it stands between me actually feeding myself daily or me forcing myself to always use fresh vegetables - I prefer feeding myself.

READ: My posts are based on my experiences as a person diagnosed with ADHD and/or relatable stories from other people diagnosed with ADHD. I’m not a medical professional and I might get facts wrong, even though I try not to. Don’t use these as a diagnostic tool. Many people, ADHD or not, can experience alot of similar things based on different circumstances. 
If you suspect that you have ADHD please research from trustworthy sources and talk to a therapist that you trust about it! 🌸

#adhd #mentalhealth #anxiety #adhdawareness #adhdawarenessmonth #adhdcelebrationweek #adhdproblems #depression #awareness #adhdlife #mentalhealthawareness #neurodiversity #adhdsupport #adhdparenting #adhdbrain #neurodivergent #parenting #adhdmemes #adhdwomen #adhdgirls #love #adultadhd #adhdmom". 

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The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder

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The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder

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Abstract

Keywords: ADHD, diagnosis, treatment, course, outcome, genetics, brain

Introduction

Nearly two decades ago, an international team of scientists published the first International Consensus Statement on attention-deficit hyperactivity disorder (ADHD) ( Barkley, 2002). They sought to present the wealth of scientific data attesting to the validity of ADHD as a mental disorder and to correct misconceptions about the disorder that stigmatized affected people, reduced the credibility of health care providers, and prevented or delayed treatment of individuals challenged by the disorder ( DosReis et al., 2010; Horton-Salway, 2013; McLeod et al., 2007; Mueller et al., 2012).

This paper updates the International Consensus Statement by cataloging important scientific discoveries from the last 20 years. We do not intend to present an encyclopedia of ADHD or guidelines for diagnosis and treatment. The latter can be found in the references cited. Our aim is to provide current and accurate information about ADHD supported by a substantial and rigorous body of evidence.

Methods

We identified evidence-based statements about ADHD through expert scrutiny of published high quality meta-analyses and very large studies. Expert scrutiny was provided by a project Steering Committee ( Supplemental Table 1) which included representatives from the following professional groups dedicated to research and clinical care of ADHD: The World Federation of ADHD, EUropean NETwork for Hyperkinetic DIsorderS (Eunethydis), the American Professional Society of ADHD and Related Disorders, the Canadian ADHD Resource Alliance, the Asian Federation of ADHD, the Latin American League of ADHD, the Australian ADHD Professionals Association, the Israeli Society of ADHD, the Saudi ADHD Society, Neurodevelopmental Disorders Across Lifespan section of the European Psychiatric Association, the ADHD Guidelines Group of the Association of Medical Scientific Societies in Germany, the ADHD Network of European College of Neuropsychopharmacology, the Chinese Society of Child and Adolescent Psychiatry and the ADHD Section of the World Psychiatric Association.

For large cohort studies, we searched PubMed with these search criteria: ADHD [tiab] AND (nationwide [tiab] OR national [tiab] OR register [tiab] OR registry [tiab]) NOT review [Publication Type] NOT meta-analysis [Publication Type]. For meta-analyses, we searched PubMed with these search criteria: ADHD [All Fields] AND (meta-analysis [Title] OR meta-analysis [Title] OR meta-analytic [Title] OR systematic review [Title]). We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required that comparison adjusted funnel plots be presented. For treatment studies, we excluded results of meta-analyses including comparisons of treatments with waiting-list or treatment as usual controls.

Apart from statements about the history of ADHD and its diagnostic criteria, we required each evidence-based statement to be supported by meta-analyses or by large registry studies with more than 2,000 participants. We required meta-analyses to report data from five or more studies or 2,000 or more participants.

We describe the magnitude of effect size findings using standard criteria as follows: standardized mean difference: small = 0.20, medium = 0.50, large = 0.80; correlation coefficient: small = 0.10, medium = 0.24, large = 0.37 ( Ellis, 2010; Rosenthal and Rosnow, 1984). "Moderate" is used as a synonym for "medium," and "strong" for "large." A "small" effect is generally difficult to observe in an individual but may be very important for public health if it concerns a common exposure that affects many children. A "medium" effect is expected to be noticeable to a careful observer ( Cohen, 1988). A "large" effect is generally relevant to clinical practice at the level of the individual.

If a topic is not included in this document, it does not mean the topic is unimportant; rather, it means the evidence found was insufficient to allow firm conclusions. This could be because there were insufficient studies of quality, because no attempt was made to assess publication bias, or because the data available did not support the claims made. After the document was completed, we invited additional colleagues to join as signatories to indicate their support of the document. In what follows, we use the term "evidence-based" to refer to evidence that meets the inclusion/exclusion criteria we used in our literature search. We recognize that other criteria could be applied, such as requiring the absence of severe heterogeneity in meta-analyses or increasing the numbers of research participants.

Overview of Results

Our search strategy generated 208 empirically supported statements about ADHD. For details, see the PRISMA diagram in Supplemental Figure 1. The status of the included statements as empirically supported has been approved by the 80 authors from 27 countries and 6 continents ( Supplemental Figure 2). It has been endorsed by 403 people who have read this document and agree with its contents ( Supplemental Table 2). Table 1 summarizes our findings along with the item numbers that support each statement. A limitation of this consensus statement is that we do not report well-established research findings for which meta-analyses or very large studies do not exist. The absence of such a study, is not always an indication of knowledge of absence of an effect.

Table 1:

Findings

Items

The syndrome we now call ADHD has been described in the medical literature since 1775.

1 - 13

When made by a licensed clinician, the diagnosis of ADHD is well-defined and valid at all ages, even in the presence of other psychiatric disorders, which is common.

14-19

ADHD is more common in males and occurs in 5.9% of youth and 2.5% of adults. It has been found in studies from Europe, Scandinavia, Australia, Asia, the Middle East, South America, and North America.

20-25

ADHD is rarely caused by a single genetic or environmental risk factor but most cases of ADHD are caused by the combined effects of many genetic and environmental risks each having a very small effect.

26-62

People with ADHD often show impaired performance on psychological tests of brain functioning, but these tests cannot be used to diagnose ADHD.

63-70

Neuroimaging studies find small differences in the structure and functioning of the brain between people with and without ADHD. These differences cannot be used to diagnose ADHD.

71-77

People with ADHD are at increased risk for obesity, asthma, allergies, diabetes mellitus, hypertension, sleep problems, psoriasis, epilepsy, sexually transmitted infections, abnormalities of the eye, immune disorders, and metabolic disorders.

78-100

People with ADHD are at increased risk for low quality of life, substance use disorders, accidental injuries, educational underachievement, unemployment, gambling, teenage pregnancy, difficulties socializing, delinquency, suicide, and premature death.

101-136

Studies of economic burden show that ADHD costs society hundreds of billions of dollars each year, worldwide.

137-147

Regulatory agencies around the world have determined that several medications are safe and effective for reducing the symptoms of ADHD as shown by randomized controlled clinical trials.

148-157

Treatment with ADHD medications reduces accidental injuries, traumatic brain injury, substance abuse, cigarette smoking, educational underachievement, bone fractures, sexually transmitted infections, depression, suicide, criminal activity and teenage pregnancy.

158-177

The adverse effects of medications for ADHD are typically mild and can be addressed by changing the dose or the medication.

178-188

The stimulant medications for ADHD are more effective than non-stimulant medications but are also more likely to be diverted, misused, and abused.

189-194

Non-medication treatments for ADHD are less effective than medication treatments for ADHD symptoms, but are frequently useful to help problems that remain after medication has been optimized.

195-208

A Brief History: ADHD is not a New Disorder

The concept of ADHD has a long history, starting with clinical reports from European countries. The clinical significance of the signs and symptoms of the disorder has been recognized for over two centuries. Although these early reports did not use the term "ADHD", they described children who showed the symptoms and impairments we now recognize as ADHD. For a detailed history see ( Lange et al., 2010; Taylor, 2011; Weikard, 1799). Here are highlights from the early history of ADHD:

1. 1775: Melchior Adam Weikard, a German physician, wrote the first textbook description of a disorder with the hallmarks of ADHD.

2. 1798: Alexander Crichton from the Royal College of Physicians (United Kingdom) described a similar disorder in a medical textbook ( Palmer and Finger, 2001).

3. 1845: Heinrich Hoffmann, who later became head of the first psychiatric hospital in Frankfurt am Main, Germany, described hyperactivity and attention deficits in a children's book which documented ADHD-like behaviors and their associated impairments ( Hoffmann, 1990).

4. 1887-1901: Désiré-Magloire Bourneville, Charles Boulanger, Georges Paul-Boncour, and Jean Philippe described an equivalent of ADHD in French medical and educational writings ( Martinez-Badia and Martinez-Raga, 2015).

5. 1902: George Still, a physician in the United Kingdom, wrote the first description of the disorder in a scientific journal ( Still, 1902a; Still, 1902b, c).

6. 1907: Augusto Vidal Perera wrote the first Spanish compendium of child psychiatry. He described the impact of inattention and hyperactivity among schoolchildren ( Vidal Perera, 1907).

7. 1917: the Spanish neurologist and psychiatrist Gonzalo Rodriguez-Lafora described symptoms of ADHD in children and said they were probably caused by a brain disorder with genetic origins ( Lafora, 1917).

8. 1932: Franz Kramer and Hans Pollnow, from Germany, described an ADHD-like syndrome and coined the term "hyperkinetic disorder", which was later adopted as a term by the World Health Organization ( Kramer and Pollnow, 1932; Neumarker, 2005).

9. 1937: Charles Bradley, from the USA, discovered that an amphetamine medication reduced ADHD-like symptoms ( Bradley, 1937).

10. 1940s: ADHD-like symptoms in children described as "minimal brain dysfunction".

11. 1960s: U.S. Food and Drug Administration approved methylphenidate (Ritalin) for behavioral disorders in children.

12. 1970s to today: Diagnostic criteria for ADHD evolved based on research showing that the diagnosis predicts treatment response, clinical course, and family history of the disorder.

How is ADHD diagnosed?

ADHD can only be diagnosed by a licensed clinician who interviews the parent or caregiver and/or patient to document criteria for the disorder ( American Psychiatric Association, 2013; Chinese Society of Psychiatry, 2001; Faraone et al., 2015; Feldman and Reiff, 2014; Pearl et al., 2001; Stein, 2008; World Health Organization, 2018). It cannot be diagnosed by rating scales alone, neuropsychological tests, or methods for imaging the brain.

The diagnosis of ADHD has been criticized as being subjective because it is not based on a biological test. This criticism is unfounded. ADHD meets standard criteria for validity of a mental disorder established by Robins and Guze ( Faraone, 2005; 1970). The disorder is considered valid because: 1) well-trained professionals in a variety of settings and cultures agree on its presence or absence using well-defined criteria and 2) the diagnosis is useful for predicting a) additional problems the patient may have (e.g., difficulties learning in school); b) future patient outcomes (e.g., risk for future drug abuse); c) response to treatment (e.g., medications and psychological treatments); and d) features that indicate a consistent set of causes for the disorder (e.g., findings from genetics or brain imaging) ( Faraone, 2005). Professional associations have endorsed and published guidelines for diagnosing ADHD ( Alliance, 2011; Banaschewski T, 2018; Bolea-Alamanac et al., 2014; Crunelle et al., 2018; Flisher, 2013; Graham et al., 2011; Kooij et al., 2019; National Collaborating Centre for Mental Health, 2018; National Institute for Health Care and Excellence, 2018; Pliszka, 2007; Schoeman and Liebenberg, 2017; Seixas et al., 2012; Taylor et al., 2004; Wolraich et al., 2011).

The main features of the diagnosis are:

1. The diagnosis requires: 1) the presence of developmentally inappropriate levels of hyperactive-impulsive and/or inattentive symptoms for at least 6 months; 2) symptoms occurring in different settings (e.g., home and school); 3) symptoms that cause impairments in living; 4) some of the symptoms and impairments first occurred in early to mid-childhood; and 4) no other disorder better explains the symptoms ( American Psychiatric Association, 2013; World Health Organization, 2018; Yi and Jing, 2015).

2. The clinical presentation of ADHD can be described as primarily inattentive, primarily hyperactive-impulsive, or combined, depending on the nature of their symptoms ( American Psychiatric Association, 2013). Meta-analyses indicate that inattention is more strongly associated with academic impairment, low self-esteem, negative occupational outcomes and lower overall adaptive functioning. Hyperactive-impulsive symptoms are associated with peer rejection, aggression, risky driving behaviors and accidental injuries. Patterns of associated disorders also differ between the dimensions ( Willcutt et al., 2012).

3. ADHD impairs the functioning of highly intelligent people, so the disorder can be diagnosed in this group. A population-based birth cohort study of over 5,700 children found no significant differences among children with high, average, or low IQ and ADHD in median age at which ADHD criteria were met, rates of learning disorders, psychiatric disorders, and substance abuse, and rates of stimulant treatment ( Katusic et al., 2011; Rommelse et al., 2017).

4. In adolescence and young adulthood, many individuals with a history of childhood ADHD continue to be impaired by the disorder, although they often show reduced hyperactivity and impulsivity while retaining symptoms of inattention ( Faraone et al., 2006).

5. Many large epidemiologic and clinical studies show that ADHD often co-occurs with other psychiatric disorders, especially depression, bipolar disorder, autism spectrum disorders, anxiety disorders, oppositional defiant disorder, conduct disorder, eating disorders, and substance use disorders ( Bernardi et al., 2012; Chen et al., 2018c; Groenman et al., 2017; Nazar et al., 2016; Solberg et al., 2018; Tung et al., 2016; Yao et al., 2019). Their presence does not rule out a diagnosis of ADHD.

6. A meta-analysis comprising 25 studies with over eight million participants found that children and adolescents who are relatively younger than their classmates are more likely to have been diagnosed with ADHD ( Caye et al., 2020)

How Common is ADHD?

ADHD occurs throughout the developed and developing world and is more common in males compared with females. It has not become more common over the past three decades although due to increased recognition by clinicians, the disorder is more likely to be diagnosed today than in prior decades.

1. A meta-analysis of 19 studies with over 55,000 participants found that 5.9% of youths meet diagnostic criteria for ADHD ( Willcutt, 2012). Another meta-analysis, with 135 studies and about a quarter of a million youths, found no significant differences in prevalence between North America and Europe, Asia, Africa, South America, and Oceania ( Polanczyk et al., 2014).

2. The latter meta-analysis found no increase in the prevalence of ADHD in children and adolescents over the past three decades ( Polanczyk et al., 2014). Although the prevalence of ADHD has not changed in this time period, large studies from the US and Sweden indicate that ADHD is more likely to have been diagnosed in recent years, which reflects changes in administrative and clinical practices ( Rydell et al., 2018; Song et al., 2019; Xu et al., 2018).

3. A meta-analysis of six studies with over 5,300 participants estimated the prevalence of ADHD in adulthood to be 2.5% ( Simon et al., 2009). A meta-analysis of 20 studies encompassing 13 countries and seven regions/metropolitan areas, involving more than 26,000 participants, estimated that 2.8% of adults meet criteria for ADHD ( Fayyad et al., 2017). The lower prevalence in adults compared with youth is consistent with a meta-analysis of 21 studies with over 1,600 participants showing that only about one in six youths with ADHD still meet full diagnostic criteria for ADHD at age 25, and about half show signs of residual impairment ( Faraone et al., 2006).

4. A meta-analysis of nine studies with a total of over 32,000 older adults found a prevalence of 2.2% based on ADHD rating scales, dropping to 1.5% when limited to persons at least fifty years old. Yet a meta-analysis of seven studies with over 11.7 million participants based on ADHD clinical diagnoses, performed by the same team, reported a prevalence of only 0.2% for persons at least fifty years old. A third meta-analysis performed by the same researchers, of four studies with over 9.2 million participants, found an ADHD treatment rate of only 0.02% among persons at least fifty years old ( Dobrosavljevic et al., 2020).

5. A meta-analysis of 19 studies encompassing over 150,000 U.S. Black youths under 18 years old reported an ADHD prevalence rate of 14 percent. The authors concluded, "Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds" ( Cénat et al., 2020).

6. ADHD is more common in males. A meta-analysis of parent ratings of symptoms in 29 studies with over 42,000 participants, and teacher ratings in 24 studies with over 56,000 participants, found a roughly two-to-one male/female ratio in youth ( Willcutt, 2012).

What causes ADHD?

For most people with ADHD, many genetic and environmental risk factors accumulate to cause the disorder ( Faraone et al., 2015). The environmental risks for ADHD exert their effects very early in life, during the fetal or early postnatal period. In rare cases, however, ADHD-like symptoms can be caused by extreme deprivation early in life ( Kennedy et al., 2016), a single genetic abnormality ( Faraone and Larsson, 2018), or traumatic brain injury early in life ( Stojanovski et al., 2019). These findings are helpful to understand the causes of ADHD but are not useful for diagnosing the disorder. The associations between aspects of the environment and the onset of ADHD have attained a very high level of evidential support. Some have strong evidence for a causal role but, for most, the possibility remains that these associations are due to correlated genetic and environmental effects. For this reason, we refer to features of the pre- and post-natal environments that increase risk for ADHD as correlates, rather than causes. The genetic and environmental risks described below are not necessarily specific to ADHD.

Environmental Correlates of ADHD: Exposure to Toxicants

Environmental Correlates of ADHD: Nutrient Deficiencies

1. A meta-analysis of nine studies and 586 people found moderately lower overall blood levels of omega-3 PUFAs in ADHD than non-ADHD youth ( Hawkey and Nigg, 2014).

2. A nationwide population-based case-control study using the Finnish national registers compared 1,067 patients with ADHD born between 1998 and 1999 with 1,067 matched controls. Lower maternal vitamin D levels were associated with a roughly 50% greater likelihood of ADHD in their children ( Sucksdorff et al., 2019).

What Have We Learned from Studying the Brains of People with ADHD?

There are two broad classes of research findings about the brains of people with ADHD. The first comes from studies of the performance of patients on psychological tests that study mental processes. The second comes from methods that directly examine brain structure or function with neuroimaging scans. Although many of these studies have found differences between groups of people who are and are not diagnosed with ADHD, the differences are typically small and do not dramatically differ between people with ADHD and those with other disorders. They are, therefore, not useful for diagnosing the disorder ( Thome et al., 2012). These differences are not caused by drug treatment and, for some patients, diminish or change as patients grow out of the disorder.

What kinds of Non-Psychiatric Medical Problems Commonly Occur among People with ADHD?

A relatively new area of research into ADHD is examining what types of medical problems are more common than expected among people with ADHD. As you read this section, keep in mind that not all people with ADHD will suffer from all, or even only one, of these disorders.

Obesity

A Swedish national register study of over 2.5 million people found ADHD patients had a threefold greater risk of obesity relative to their non-ADHD siblings and cousins. It also found a familial co-aggregation of ADHD and clinical obesity, the strength of which varied directly with the degree of genetic relatedness ( Chen et al., 2018c).

Allergies and Asthma

In a meta-analysis of six longitudinal studies with over 50,000 participants, those with asthma or atopic eczema were a third more likely to have ADHD than controls. A meta-analysis of three studies with over 48,000 participants found that those with allergic rhinitis were about 50% more likely to have ADHD ( van der Schans et al., 2017).

Diabetes Mellitus:

Other Somatic Disorders:

What is the Impact of ADHD on Patients and Families?

ADHD is a disorder associated with serious distress and/or impairments in living. Although, as documented below, many severe adverse outcomes have been associated with ADHD, the typical patient does not experience all, or even most, of these problems. Many patients live enjoyable and productive lives, especially if they receive treatment.

Quality of Life

1. A meta-analysis of seven studies with over 5,000 youths and their parents reported large impairments in the quality of life of youths with ADHD relative to typically developing peers, regardless of whether evaluated by the youths themselves or by their parents. Physical functioning was only moderately impaired, but emotional functioning and social functioning was strongly impaired. School functioning was strongly impaired. As youths with ADHD grew older, their quality of life compared with typically developing peers grew worse in physical, emotional, and school domains. ( Lee et al., 2016).

2. A meta-analysis of 17 studies encompassing 647 families (over 2,300 participants) evaluated the quality of life of parents whose children had ADHD relative to parents with typically developing children. Parents of the former reported a moderate deficit in quality of life relative to parents of the latter ( Dey et al., 2019).

Emotional and Social Impairment

1. A study of over 8,600 youths from the US National Health Interview Survey found that those with ADHD were six times as likely to have a high level of emotional, conduct, and peer problems, and nine times as likely to manifest a high level of impairment including interference with home life, friendships, classroom learning, and leisure activities ( Strine et al., 2006).

2. A meta-analysis found that children with ADHD had medium-to-large impairments in socializing with peers as measured by rejection/likability, popularity, and friendships (61 studies, over 24,000 children). They also had moderate impairments in social skills such as sharing, cooperating, turn-taking, reciprocity (68 studies, over 148,000 children), and social-information processing, such as recognizing social cues, identifying problems, generating solutions, and avoiding biases (23 studies, over 3,750 children) ( Ros and Graziano, 2018).

Crime and Delinquency

1. A study of the Danish population using nationwide registers found that, compared with other youth, those diagnosed with ADHD were more than twice as likely to be convicted of criminal offenses and were three times as likely to be incarcerated. After adjusting for other risk factors, those with ADHD were 60% more likely to have been convicted of a crime, and 70% more likely to have been incarcerated ( Mohr-Jensen et al., 2019).

2. A study using a nationally representative American sample of over 5,000 adults found that those with ADHD were over twice as likely to be perpetrators of physical dating violence, and 65% more likely to be victims of such violence ( McCauley et al., 2015).

3. In a nationwide study of over 21,000 Icelandic adolescents and young adults, 14% reported having been interrogated at a police station. Of these, 15% reported making a false confession. Those with ADHD were twice as likely to make a false confession ( Gudjonsson et al., 2016).

4. A study using the Danish national registries looked at violent crimes against youth aged 7-18 years, among a total of 678,000 individuals. Children with ADHD were 2.7 times more likely to be victims of violent crimes than their typically developing peers, after adjusting for confounding risk factors ( Christoffersen, 2019).

Educational Underachievement

1. A study of a U.S. sample of almost 30,000 adults found that those with ADHD were twice as likely not to have graduated from high school on time, after adjusting other psychiatric disorders ( Breslau et al., 2011).

2. A nationwide cohort study of over 750,000 Scottish school children using linked national registers identified those who had been prescribed medicine for ADHD. Even while receiving medication, these children were more than three times as likely as typically developing peers to have low educational achievement, more than twice as likely to drop out of school before age 16, more than eight times as likely to have a record of special educational needs, 50% more likely to get injured, 40% more likely to be unemployed. These results were adjusted for socioeconomic confounders and other psychiatric conditions ( Fleming et al., 2017).

3. 127. A meta-analysis of ten studies and 830 youths found that ADHD was strongly associated with poorer performance on measures of overall, expressive, receptive, and pragmatic language ( Korrel et al., 2017).

Substance Use Disorders

1. A meta-analysis of twelve studies covering over 5,400 people found that those with ADHD were almost three times more likely to be nicotine-dependent. Combining eleven studies with almost 2,400 participants, those with ADHD were 50% more likely to develop a drug or alcohol use disorder than those without ADHD ( Lee et al., 2011).

2. A meta-analysis found that ADHD was associated with a more than twofold greater odds of alcohol-use disorders (13 studies, over 20,000 participants) and nicotine-related disorder (14 studies, over 1,800 participants) ( Groenman et al., 2017).

3. A Swedish study of over half a million people found a more than threefold association between ADHD and subsequent drug use disorders after adjusting for sex and parental education ( Sundquist et al., 2015).

What is the Economic Burden of ADHD?

Given the many adverse outcomes associated with ADHD, it will come as no surprise to readers that these effects have a substantial economic cost to individual patients, families, and society.

1. A systematic review of seven European studies of hundreds of thousands of participants estimated total ADHD-related costs in the Netherlands as €9,860 to €14,483 per patient per year, with annual national costs more than €1 billion ( Le et al., 2014).

2. A review of the costs of child, youth and adult ADHD in Australia estimated the total annual costs to be over $20 billion Australian dollars, or $25,000 per person with ADHD. This includes financial costs of $12.8 billion, well-being losses of $7.6 billion, and productivity losses of $10.2 billion ( Australian ADHD Professionals Association, 2019).

3. A systematic review of 19 U.S. studies of hundreds of thousands of people found that ADHD was associated with overall national annual costs from $143 to $266 billion, mostly associated with adults ($105 to $194 billion). Costs borne by family members of people with ADHD ranged from $33 - $43 billion ( Doshi et al., 2012).

4. A study with over 7,000 workers in ten nations found that those with ADHD had an average of 22 annual days of lost role performance compared with those without ADHD ( de Graaf et al., 2008).

5. A study of a U.S. national Fortune 100 company's database of over 100,000 beneficiaries compared healthcare costs for youths with ADHD with matched controls without ADHD. The annual average cost per family member was $2,728 for non-ADHD family members of ADHD patients, almost double the $1,440 for family members of matched controls ( Swensen et al., 2003).

6. German health insurance records, including over 25,000 patients with ADHD, indicate that patients with ADHD cost roughly €1,500 more annually than those without ADHD. Main cost drivers were inpatient care, psychiatrists, and psychotherapists. Mood, anxiety, substance use disorders, and obesity were significantly more frequent in patients with ADHD. The additional costs resulting from these conditions added as much as €2,800 per patient ( Libutzki et al., 2019).

7. Using the National Health Insurance Service claims data for the population aged 19 years or younger in South Korea (69,353 diagnosed with ADHD), the total annual economic burden due to ADHD was estimated to be $47.55 million ( Hong et al., 2020).

8. Using the Danish national registers, over 5,000 adults with a diagnosis of ADHD in adulthood who had not received a diagnosis in childhood were identified. Excluding cases with missing data, other psychiatric diagnoses, and cases without a same-sex sibling free of any diagnosed psychiatric diagnoses, a final cohort was formed consisting of 460 sibling pairs. On average, adults with ADHD had an annual economic burden of just over €20,000 compared with their normally developing siblings ( Daley et al., 2019).

9. A nationwide cohort study of over 445,000 people in the Swedish national registers compared healthcare costs for three groups: those with childhood ADHD that persisted into adulthood, those whose ADHD remitted in adulthood, and those who never had ADHD. Those who never had ADHD had average annual healthcare costs of €304. Those in remission had double the cost, and those with persistent ADHD over triple the cost ( Du Rietz et al., 2020).

10. A nationwide population study of over 83,000 persons with ADHD and 334,446 non-ADHD controls matched by age and sex used Danish national registries to calculate the net socioeconomic cost of ADHD. Relative to controls, and summing net direct health costs and net losses from lower income and employment, the yearly average cost per individual with ADHD came to just over €16,000. Including additional social transfers, the total rose to just over €23,000. For partners of persons with ADHD, the additional yearly average cost per individual was almost €5,500. With additional social transfers, the total rose to €8,000 ( Jennum et al., 2020).

11. Using a database that tracks more than sixty German nationwide health insurance programs, a study of five million member records identified 2,380 individuals first diagnosed with ADHD as adults. Their direct healthcare costs in the year following diagnosis averaged €4,000. Despite explicit German guidelines recommending ADHD medication, only a third were prescribed medication, dropping to one eighth four years later. Two-thirds received psychotherapy. The authors concluded that "guideline recommendations are not yet comprehensively implemented in everyday routine care" ( Libutzki et al., 2020).

Which Medications are Safe and Effective for Treating ADHD?

As determined by governmental regulatory agencies around the world, several medications are safe and effective for treating ADHD symptoms as determined by randomized controlled clinical trials that typically study patients for several weeks. These medications, which are as efficacious, or more efficacious, than many medications used for non-psychiatric disorders ( Leucht et al., 2012), are classified as either stimulants (methylphenidate and amphetamine) or non-stimulants (atomoxetine, extended release guanfacine, and extended release clonidine).

Effects of Medications on Impairments Associated with ADHD: Results from Naturalistic Studies

Effects of Medications for ADHD on the Brain

A meta-analysis of methylphenidate treatment for ADHD found moderate improvements in response inhibition (25 studies, 787 participants) and sustained attention (29 studies, 956 participants), but no significant effect on working memory (13 studies, 559 participants) ( Tamminga et al., 2016).

Adverse Effects of ADHD Medications

Which Non-Medication Treatments are Safe and Effective for ADHD?

Many non-medical treatments have been proposed for ADHD. Most of those offered on the Internet have not been tested or have been shown not to be effective. In this section, we distinguish between the effects of a treatment for ADHD symptoms and other benefits it may confer. Due to the way these therapies are implemented and recorded in the medical record, large scale naturalistic studies of longer-term outcomes are not possible.

Behavioral and Cognitive-Behavioral Therapies

Behavioral treatments for ADHD are diverse in nature and have a different content and focus depending on the age of the patient. For preschoolers and grade-school children, parents are trained to improve their method of disciplining and interacting with their children. For adolescents and adults, therapy helps patients improve their organizational skills. For some patients, teachers contribute to a program aimed at improving the child's behavior. Some of these therapies focus on improving social behaviors and developing practical skills. In this section, however, we focus only on the ability of such treatments to improve ADHD symptoms. Readers should keep in mind that the failure of a treatment to substantially improve ADHD symptoms does not mean it is not useful for other purposes.

A meta-analysis found parent training for preschool children with ADHD to be associated with a moderate reduction in parent-reported ADHD symptoms (15 studies, few with active controls, over a thousand participants) and conduct problems (14 studies, few with active controls, over a thousand participants), but no significant results for independently assessed ADHD symptoms (6 studies, 403 participants) and conduct problems (6 studies, 311 participants). Independent assessments reported a small reduction in negative parenting (10 studies, 771 participants) ( Rimestad et al., 2019).

1. A meta-analysis of 32 studies with over two thousand participants found that cognitive training resulted in small to moderate improvements in executive functioning in preschoolers with ADHD ( Scionti et al., 2019).

2. A meta-analysis explored the effectiveness of meditation-based therapy. It found moderate reductions in ADHD symptoms in both children and adolescents (6 RCTs, 240 participants) and adults (6 RCTs, 339 participants), but half the studies did not use active controls. Removing studies with waiting list controls made results nonsignificant. The authors concluded "there is insufficient methodologically sound evidence to support the recommendation of meditation-based therapies as an intervention aimed to target ADHD core symptoms or related neuropsychological dysfunctions in children/adolescents or adults with ADHD" ( Zhang et al., 2018).

3. A meta-analysis found that social skills training for youth with ADHD did not improve teacher-assessed social skills (11 studies, over 1,200 youths), general behavior (8 studies, over 1,000 youths), or school performance and grades (5 studies, over 600 youths) ( Storebo et al., 2019).

4. A meta-analysis of ten studies with 893 youths reported that organizational skills interventions led to moderate reductions in parent-reported inattention symptoms ( Bikic et al., 2017).

Computer-based Cognitive Training and Neurofeedback

A meta-analysis found that working memory training led to short-term improvements in both verbal working memory (21 studies, over 1,300 participants) and visuospatial working memory (18 studies, over 1,000 participants), with "no convincing evidence that even such near-transfer effects are durable." Moreover, most of the studies lacked active controls ( Melby-Lervag and Hulme, 2013).

Supplements, Diet, and Exercise

1. A meta-analysis found no evidence of any effect of omega-3 fatty acid supplements on parent-rated (5 studies, 650 children) or teacher-rated (3 studies, 598 children) emotional lability symptoms, or parent-rated (8 studies, 875 children) or teacher-rated (6 studies, 805 children) oppositional symptoms in children with ADHD ( Cooper et al., 2016).

2. A meta-analysis of five double-blind crossover studies with 164 participants found that restricting synthetic food colors from children's diets was associated with a small reduction in ADHD symptoms ( Nigg et al., 2012).

3. A nationwide population study using the Swedish Twin Register identified almost 18,000 twins who completed a web-based examining the relationship between inattention and hyperactivity/impulsivity subtypes and dietary habits. The two subtypes of ADHD exhibited very similar associations. Both had significant associations with unhealthy diets. Both were more likely to be eating foods high in added sugar and neglecting fruits and vegetables while eating more meat and fats. After adjusting for degree of relatedness of twins (whether monozygotic or dizygotic) and controlling for the other ADHD subtype, the associations remained statistically significant for inattention, but diminished to negligible levels or became statistically nonsignificant for hyperactivity/impulsivity. Even for persons with inattention symptoms, adjusted correlations were small (never exceeding r = 0.10), with the strongest associations being for overall unhealthy eating habits and eating foods high in added sugar. Among over 700 pairs of monozygotic ("identical") twins, it found small but robust associations between inattention symptoms and unhealthy eating habits, and especially with consumption of foods high in added sugar. For hyperactivity/impulsivity symptoms, the association with unhealthy eating habits was weaker, and the association with consumption of foods high in added sugar became statistically insignificant ( Li et al., 2020).

Discussion

This work has curated evidence-based statements about ADHD which paint a picture of the disorder that we summarize as follows:

ADHD is a chronic disorder in which developmentally inappropriate symptoms of inattention and/or hyperactivity/impulsivity lead to impairments in many aspects of living. The disorder, which starts in childhood or early adolescence and is more common in boys than girls, affects 5.9% of youth and 2.8% of adults worldwide. There are multiple genetic and environmental risk factors that accumulate in various combinations to cause ADHD. These risk factors lead to subtle changes in multiple brain networks and in the cognitive, motivational, and emotional processes they control. People diagnosed with ADHD have an elevated risk for school failure, antisocial behavior, other psychiatric problems, somatic disorders, drug and alcohol abuse, accidental injuries, and premature death, including attempted and completed suicide. As a result, ADHD costs society hundreds of billions of dollars each year. Several medications are safe and effective for treating ADHD and for preventing many adverse outcomes. Non-medication treatments are available but, compared with medications, are less effective for reducing inattention, hyperactivity, and impulsivity.

Despite this large body of evidence, we have much more to learn about the disorder and its various manifestations. Epidemiologic studies have taught us that ADHD occurs around the world, but we know little about how culture affects the expression of ADHD symptoms or the response to treatment. Because most research about ADHD is based on Caucasian and East Asian samples, we must be cautious in generalizing our assertions to other groups. In addition, far more research pertains to males than females. We also need to learn more about ADHD in older adults. Future research into ADHD should examine more diverse samples from a wider range of cultural contexts.

We have learned much about the causes of ADHD but are only beginning to understand how genes and environment combine to cause the disorder and affect the brain to produce symptoms and impairments. Some of these causes may be shared with ADHD's somatic comorbidities. Examples include oxidative stress, inflammation, and insulin resistance. Future work should focus on biological and psychological causal mechanisms to find points of intervention that will improve the effectiveness of medical and non-medical treatments and, eventually, prevent onset of the disorder. Although the medications that treat ADHD are highly effective, we need better methods to prevent the misuse and diversion of these medications, especially among adolescents and young adults ( Faraone et al., 2020).

Many decades of research have led to a method of diagnosing ADHD that is highly valid as a predictor of treatment response, family history of ADHD, many clinical features, measures of brain structure and function, and adverse outcomes. Nevertheless, there are several new directions for diagnosis. One is to better understand the nature and causes of emotional symptoms in ADHD and whether these should be incorporated into diagnostic criteria ( Faraone et al., 2019b). Another is to determine if and how mild or sub-threshold cases of ADHD should be diagnosed and treated ( Kirova et al., 2019). Different trajectories of ADHD across the life-cycle need to be further investigated.

Many researchers are trying to develop computerized or biological tests using information about the patient's behavior, brain and/or genetic makeup. The hope is that such tests will one day diagnose the disorder, predict a personalized approach to treatment or assist clinicians in these areas. Others are working on methods that use the vast data available from medical records to predict which patients with ADHD are at greatest risk for adverse outcomes later in life. Such work may someday allow healthcare systems to allocate resources to the highest risk patients.

Although we have good treatments for ADHD, even the best treatments are only partially effective. The future of treatment for ADHD will include new medications currently in development and a stronger evidence base for novel non-medication treatments for treating ADHD symptoms or associated impairments, such as trigeminal nerve stimulation ( McGough et al., 2019) and game-based treatments ( Craven and Groom, 2015; Dovis et al., 2015). And more data are needed to improve existing non-medication treatments and to test the efficacy of traditional therapies such as acupuncture, yoga, and Ayurvedic therapies. Also, little is known about how the somatic disorders that co-occur with ADHD interact with treatments for ADHD and how the symptoms of the disorder affect somatic outcomes. We need to learn more about how duration of treatment affects outcomes over longer periods of time.

We also know little about stigma and ADHD. Stigmatizing attitudes toward ADHD are common and may play a role in socially and clinically important outcomes. These negative attitudes affect patients at all stages of their life. Such attitudes have been documented among individuals at all ages and in all groups, including family, peers, teachers, clinicians, and even individuals with ADHD themselves ( Lebowitz, 2016).

Despite these and other gaps in our knowledge about ADHD, nearly two and a half centuries after the first textbook description of an ADHD-like syndrome, the statements about ADHD which we have curated, make us confident that the contemporary diagnosis of the disorder is a valid and useful category that can be used around the world to improve the lives of the many people who suffer from the disorder and its complications.

Supplementary Material

Supplemental Fig 1-2 and Table 1

Acknowledgments

Financial Disclosures

S.V.F. In the past year, he received income, potential income, travel expenses continuing education support and/or research support from, Akili Interactive Labs, Arbor, Genomind, Ironshore, Ondosis, Otsuka, Rhodes, Shire/Takeda, Sunovion, Supernus, Tris, and Vallon. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. In previous years, he received support from: Alcobra, CogCubed, Eli Lilly, Enzymotec, Janssen, KemPharm, Lundbeck/Takeda, McNeil, Neurolifesciences, Neurovance, Novartis, Pfizer, and Vaya. He also receives royalties from books published by Guilford Press: Straight Talk about Your Child's Mental Health; Oxford University Press: Schizophrenia: The Facts; and Elsevier: ADHD: Non-Pharmacologic Interventions. He is also Program Director of www.adhdinadults.com. He is supported by the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602805, the European Union's Horizon 2020 research and innovation programme under grant agreements No 667302 & 728018 and NIMH grants 5R01MH101519 and U01 MH109536-01.

T.B. reports the following financial disclosures in the last 3 years: Advisory/consultant/speaker for ADHS digital, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Shire/Takeda, Roche, and Infectopharm. Royalties from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press.

D.C reports the following financial disclosures over the last 5 years. Advisory Board: Shire/Takeda, Honoraria and Travel Support: Shire/Takeda, Medice, Servier, Royalties: Oxford University Press.

Y.Z. reports receiving grant funding for research on prevention and control of major chronic non-communicable diseases with Attention Deficit Hyperactivity Disorder in the Ministry of Science and Technology ( No: 2016YFC1306100).

J.B. is currently receiving research support from the following sources: AACAP, Feinstein Institute for Medical Research, Food & Drug Administration, Genentech, Headspace Inc., NIDA, Pfizer Pharmaceuticals, Roche TCRC Inc., Sunovion Pharmaceuticals Inc., Takeda/Shire Pharmaceuticals Inc., Tris, and NIH. Dr. Biederman's program has received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Biomarin, Bracket Global, Cogstate, Ingenix, Medavent Prophase, Shire, Sunovion, and Theravance; these royalties were paid to the Department of Psychiatry at MGH. In 2020: Through MGH corporate licensing, Dr. Biederman has a US Patent (#14/027,676) for a non-stimulant treatment for ADHD, a US Patent (#10,245,271 B2) on a treatment of impaired cognitive flexibility, and a patent pending (#61/233,686) on a method to prevent stimulant abuse. He receives honoraria from the MGH Psychiatry Academy for tuition-funded CME courses. In 2019, Dr. Biederman was a consultant for Akili, Avekshan, Jazz Pharma, and Shire/Takeda. He received research support from Lundbeck AS and Neurocentria Inc. Through MGH CTNI, he participated in a scientific advisory board for Supernus.

M.A.B. in the last five years has received travel support and speaker fees from Shire Pharmaceuticals. He was on the Scientific Advisory Board of Tali Health, the developers of a cognitive training game for ADHD and other neurodevelopmental disorders. MAB is supported by a Senior Research Fellowship from the National Health and Medical Research Council (NHMRC) of Australia. He is President of the Australian ADHD Professionals Association (AADPA).

J.H.N reports the following financial disclosures in the past three years: is/has been an advisor and/or consultant for Adlon Therapeutics, Akili Interactive, Arbor, Cingulate Therapeutics, Corium, Eisai, Enzymotec, Lundbeck, Medice, Myriad Neuroscience, NLS, OnDosis, Rhodes, Shire/Takeda, and Supernus. He was a DSMB member for Pfizer and Sunovion, received research funds from Enzymotec, Otsuka, Shire and Supernus, and received speaker fees from Shire/Takeda for disease-state presentations.

M.G. reports the following financial disclosures: Advisory Boards: Purdue, Takeda, and Janssen.

N.M.A. has no conflicts of interest or financial disclosures to report.

I.M. reports the following financial disclosures for the last 3 years: Consultant: Novartis Israel, Teva Israel, Medison Ltd. Advisory Board: Teva (2018). Honorariums: Amaoon, Takeda, and MHS virtual summit. She has also received PI funding from Alcobra (S/P), Nuance Ltd.

L.A.R. reports the following financial disclosures: he has been a member of the speakers' bureau/advisory board and/or acted as a consultant for Bial, Eli-Lilly, Janssen-Cilag, Medice, Novartis, Pfizer and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. He received travel grants fromShire for attending the 2018 APA meetings. He also receives research support from Brazilian government institutions: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Hospital de Clínicas de Porto Alegre (HCPA), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

L.Y. reports the following financial disclosures: has been a member of the speakers' bureau and/or acted as a consultant for Eli-Lilly and Janssen. Has also received grant funding from National Natural Science Foundation of China (81671358, 81873803).

S.C. declares reimbursement for travel and accommodation expenses from the Association for Child and Adolescent Central Health (ACAMH) in relation to lectures delivered for ACAMH, Canadian AADHD Alliance Resource (CADDRA), British Association of Psychopharmacology (BAP), and from Healthcare Convention for educational activity on ADHD.

D.A. reports the following financial disclosures in the last 3 years: Advisory/consultant/speaker for Shire/Takeda, Janssen and Elvium/Purdue

M.A.S. has received research support: Supernus, Akilli, Shire. Advisor: Genomind, Shire/Takeda, Cingulate, Eisai.

T.H.A. has no conflicts of interest or financial disclosures to report.

H.F.A. has no conflicts of interest or financial disclosures to report.

M.M.J.A. has no conflicts of interest or financial disclosures to report.

P.A. has received honoraria for consultancy to Shire/Takeda, Eli-Lilly and Novartis; educational/research awards from Shire, Lilly, Novartis, Vifor Pharma, GW Pharma and QbTech; speaker at sponsored events for Shire, Lilly, Flynn Pharma and Novartis. He has also received grant funding support from NIHR Biomedical Research Centre (NIHR/MRC 14/23/17) and NIHR Senior Investigator award (NF-SI-0616-10040).

L.A. has received grant funding from the National Institutes of Health; Broad Institute of MIT and Harvard. Also received funding from Tonix Pharmaceuticals for research on PTSD treatment.

S.B. reports the following financial disclosures in the last 3 years: Advisor/consultant/speaker for Medice and Roche. Royalties from Hogrefe, Kohlhammer and UTB.

J.K.B. has been in the past 3 years a consultant to / member of advisory board of / and/or speaker for Takeda/Shire, Roche, Medice, Angelini, Janssen, and Servier. He is not an employee of any of these companies, and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties.

C.L.C. has no conflicts of interest or financial disclosures to report.

D.D. reports grants, personal fees and non-financial support from Shire/Takeda. Personal fees and non-financial support from Medice and Eli Lilly. Non-financial support from QbTech. And book royalties from Jessica Kingsley from the self-help version of the New Forest Parenting Programme and fees from the provision of training and supervision for the New Forest Parent Training Programme.

S.D. received research supported by grants from The Lundbeck Foundation (iPSYCH grant no R248-2017-2003), National Institute of Health (R01, grant no ES026993), Novo Nordisk Foundation (grant no 22018), the European Commission (Horizon 2020, grant no 667302), Tryg Foundation (109399), Helsefonden (grant no 19-8-0260) and the European Union's Horizon 2020 research and innovation programme under grant agreement No 847879.

M.D. reports the following financial disclosures over the last 3 years: consulting income and research support from Lilly, Medice, Shire, Takeda, and Vifor. He received income as head, supervisor, and lecturer of the School of Child and Adolescent Cognitive Behaviour Therapy at the University Hospital Cologne and as consultant for Child Behaviour Therapy at the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung). He also received royalties from treatment manuals, books and psychological tests published by Beltz, Elsevier, Enke, Guilford, Hogrefe, Huber, Kohlhammer, Schattauer, Springer, Wiley.

S.E. has no conflicts of interest or financial disclosures to report.

M.F. has no conflicts of interest or financial disclosures to report.

B.F. has received educational speaking fees from Medice. She also received grant funding from the Netherlands Organization for Scientific Research (NWO) Vici Innovation Program (personal grant 016-130-669 to B.F.), European Community Horizon 2020 Programme (H2020/2014 - 2020) under grant agreement nº 667302 (CoCA).

M.G. is on the board of the WFADHD.

J.H. reports the following financial disclosures in the last 3 years: he has received lecture honoraria from Shire, HB Pharma, Takeda, Medice and Biocodex.

C.A.H. has no conflicts of interest or financial disclosures to report.

C.M.H. has received grant support from the Institutional Development Award (IDeA) from NIGMS.

S.P.H. has received book royalties from Oxford University Press and St. Martin's Press, as well as grant support from N.I.H.

P.J.H. was member of an advisory board meeting of Takeda

C.H. reports lecture fees and honorarium in 2019 from the British Association of Psychopharmacology (BAP). He has also received funding from the National Institute for Health Research (NIHR); UK Medical Research Council (MRC).

S.H.K. reports the following financial disclosures: Akili Interactive (Research Support, Consulting Stock Options), Behavioral Innovations Group (Equity), Bose Corporation (Research Support), Tris Pharma (Research Support), Neos (Research Support), Sana Health (Research Support), OnDosis (Research Support), KemPharm (Research Support). He has also received funding from the NIH, John Templeton Foundation.

J.J.S.K. receives research support from Parnassia Groep, the Netherlands.

J.K. has given talks at educational events sponsored by Medice; all funds are received by King's College London and used for studies of ADHD.

H.L has served as a speaker for Evolan Pharma and Shire/Takeda and has received research grants from Shire/Takeda; all outside the submitted work.

T.L. receives research support from the Joint medical research project of Chongqing Science and Technology Bureau and Health Committee (Key project, Project No.: 2018zdxm012): Chinese research and promotion of Manual for Primary Care Clinicians about the Diagnosis and Treatment of Children with Attention Deficit Hyperactivity Disorder (4th Edition).J.L. has no conflicts of interest or financial disclosures to report.

J.L. is a speaker for Eli-Lilly, Janssen, Otsuka and Abbott. Has received some funding for autism research not ADHD

E.M. reports the following financial disclosures in the last 3 years: Advisory/Lecture for: Teva Israel, Medison Ltd. He also received grant support from the Israel Ministry of Health.

G.M has received grant funding from Akili, Alcobra, Alkermes, Allergan, Axsome, Boehringer, Genentech, Jansen, Lundbeck, Medgenics, NLS Pharma, Otsuka, Reckitt Benckiser, Roche, Sage, Shire, Sunovion, Supernus, Takeda, Taisho and Teva.

P.M. reports the following financial disclosures: Shire/Takeda speaker's honoraria, advisory board and travel awards.

S.M. has no conflicts of interest or financial disclosures to report in the past three years.

A.Y.M. has received funding from the Institute of Education Sciences; Michael Smith Foundation for Health Research; Social Sciences and Humanities Research Council of Canada.

B.S.G.M. has received grant funding from the National Institutes of Health.

J.T.N. has received grant funding support from the National Institute of Mental Health.

D.P.O. reports financial disclosures from Shire (advisory board /speaker fees 2016-2018), travel/accommodation/honoraria from Medice, speaker fees from Otsuka and Janssen, travel/accommodation support from HAC Pharma, scientific committee of a study by Mensia without personal fees.

O.O.O. has no conflicts of interest or financial disclosures to report.

G.V.P. reports the following financial disclosures: Advisor/consultant/speaker for Takeda and Medice, Aché, Novo Nordisk, travel expense for attending AACAP2019 Meeting from Takeda, royalties from Editora Manole. He also received grant funding from São Paulo Research Foundation (FAPESP, grant 2016/22455-8) and National Council for Scientific and Technological Development (CNPq, grant 310582/2017-2).

Y.P. has no conflicts of interest or financial disclosures to report.

A.S.P. has received personal fees and non-financial support from Shire/Takeda.

R.P.R. has no conflicts of interest or financial disclosures to report.

A.R. has no conflicts of interest or financial disclosures to report.

A.R. reports the following financial disclosures in the last 3 years: Advisor/consultant/speaker for Medice, Janssen, SAGE, Servier and Shire/Takeda. He has also received grant support from the EC.

K.R. has received a grant from Takeda Pharmaceuticals.

J.R. has no conflicts of interest or financial disclosures to report.

M.R. has received grant funding from the German Federal Ministry of Education and Research (BMBF) Grant 01EE1408.

J.A.R.Q. was on the speakers' bureau and/or acted as consultant for Eli-Lilly, Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogui, Lundbeck, Almirall, Braingaze, Sincrolab, Medice and Rubió in the last 5 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Rubió, Shire, Takeda, Shionogui, Bial, Medice and Eli- Lilly. The Department of Psychiatry chaired by him received unrestricted educational and research support from the following companies in the last 5 years: Eli-Lilly, Lundbeck, Janssen- Cilag, Actelion, Shire, Ferrer, Oryzon, Roche, Psious, and Rubió. He also received grant funding from the Department of Health of the Government of Catalonia.

Arnt S. has been supported by a Veni Grant from the Dutch Science Organization (ZonMW).

Anouk S. has no conflicts of interest or financial disclosures to report.

R.S. reports the following financial disclosures for the past 3 years: Sponsorships from Janssen, Lundbeck, Cipla, Dr Reddy and Takeda; Speaker fees from Servier, Sanofi/Zentiva, Janssen, Lundbeck, Lilly, Dr Reddy, Adcock, Novartis and Takeda; Pharmaceutical board membership: Lundbeck, Adcock, Lilly and Mylan.

J.B.S. has no conflicts of interest to report and has received salary support the current year from 2R01 MH091068, 1R03 HD087091, R61 MH110043, R01 MH113855, UL1 TR0011860 and 1TL 1TR001861.

H.S. has no conflicts of interest or financial disclosures to report.

M.V.S. has received grant funding from the National Institute of Health.

E.S.B. reports the following financial disclosures over the last three years: MRC, ESRC, Wellcome Trust, The Waterloo Foundation, University of Copenhagen, KU Leuven, Shire/Takeda, Neurtech Solutions, QBTech.

C.S. in 2019-2020 reports the following financial disclosures: Lundbeck (Clinical Trial, Departmental Funds), NeuroTech Solutions, Medice (Advisory Board), Rubio (Speaker), Editorial Medica Panamericana (Book Royalties).

H.C.S. has no conflicts of interest or financial disclosures to report.

J.M.S reports the following financial disclosures: Advisory Board for Medice; travel support from Medice and Shire/Takeda

A.T. had research funded by Wellcome Trust, MRC, ESRC and Waterloo Foundation.

G.T. has no conflicts of interest or financial disclosures to report.

G.vd.G. has no conflicts of interest or financial disclosures to report.

W.v.B financial disclosures for the last 3 years include: Consultant: Novartis, Indivior, Takeda, Opiant, D&A Pharma; Speaker's Fees: Angelini, Recordati.

S.V.O has no conflicts of interest or financial disclosures to report.

A.V. has no conflicts of interest or financial disclosures to report.

B.V. has been a consultant for Medice, Lundbeck, Angelini, and Alkermes Pharmaceuticals, and for law firms Goodwin & Procter and Haynes & Boone. He holds no stocks of pharmaceutical companies.

S.W. has received in the last 5 years royalities from Thieme Hogrefe, Kohlhammer, Springer, Beltz. Received lecture honoraria from Opopharma in the last 5 years.Her work was supported in the last 5 years by the Swiss National Science Foundation (SNF), diff. EU FP7s, HSM Hochspezialisierte Medizin of the Kanton Zurich, Switzerland, Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, Gertrud Thalmann Fonds. Outside professional activities and interests are declared under the link of the University of Zurich www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web.

Y.W. receives research support from Sanming Project of Medicine in Shenzhen "The ADHD research group from Peking University Sixth hospital"(SZSM201612036), the Major State Basic Research Development Program of China (973Program, 2014CB846100).

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The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder

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Keywords: ADHD, diagnosis, treatment, course, outcome, genetics, brain Nearly two decades ago, an international team of scientists published the first International Consensus Statement on attention-deficit hyperactivity disorder (ADHD) ( Barkley, 2002).

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Building on executive functioning skills

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Building on executive functioning skills

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242 likes, 1 comments - autism_mama_aus on July 11, 2024: "#autism #autismawareness #autismacceptance #asd #specialneeds #autistic #autismfamily  #autismspectrum #autismsupport  #autismspeaks #autismspectrumdisorder #autismparents #neurodiversity #inclusion #specialeducation #autismtraits #autismcharacteristics #sensory #understandingautism #executivefunctioning". 

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ludovico saint amour di chanaz on Instagram: "ADHD in the workplace #adhd #work #adhdawareness #adhdprobs #adhdcuriosities #braincuriosities #learn #infographic #neurodivergent"

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872 likes, 13 comments - brain.curiosities on September 23, 2024: "ADHD in the workplace #adhd #work #adhdawareness #adhdprobs #adhdcuriosities #braincuriosities #learn #infographic #neurodivergent". 

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Why ADHDers feel pressure to always be ON

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Why ADHDers feel pressure to always be ON

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Jami Fregeau | ADHD Life Strategies & Education on Instagram: "For adults with ADHD, it often feels like we have to hide our struggles just to keep up with everyone else. We’re constantly trying to match neurotypical standards, feeling the pressure to be productive, organized, and focused—without a break. But underneath that facade of being ‘on,’ there’s usually a lot of overwhelm.

🌟 Feeling like we have to hide our struggles to keep up
🌟 Trying to match neurotypical standards without a break
🌟 The fear that resting will make everything fall apart
🌟 Putting on a brave face even when we’re overwhelmed
🌟 Constantly switching between tasks, feeling like we're barely holding things together

The fear of resting is real. We worry that if we stop, everything we’ve worked so hard to maintain will fall apart. Whether it’s at work, in relationships, or in everyday life, the pressure to keep going, to keep pushing, can be exhausting. It’s like carrying the weight of expectations that don’t fit who we are or how our brains work.

But it’s okay to pause. It’s okay to rest. You don’t always have to be ‘on’ to be enough.

Do you feel like you’re always ‘on’?

#ADHDLife
#ADHDStrength
#ADHDWarrior
#ResilientADHDer
#NeurodivergentPride
#ADHDWins
#CreativeMindset
#ADHDJourney
#ADHDAwareness
#ADHDSupport
#MentalHealthMatters
#ADHDCommunity
#LivingWithADHD
#EmbraceYourADHD
#NeurodivergentStrength
#BounceBackStronger
#ADHDInAdults
#OvercomeChallenges
#CreativeProblemSolving
#ThriveWithADHD"

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865 likes, 25 comments - theneurodivergentnurse on September 11, 2024: "For adults with ADHD, it often feels like we have to hide our struggles just to keep up with everyone else. We’re constantly trying to match neurotypical standards, feeling the pressure to be productive, organized, and focused—without a break. But underneath that facade of being ‘on,’ there’s usually a lot of overwhelm.

🌟 Feeling like we have to hide our struggles to keep up
🌟 Trying to match neurotypical standards without a break
🌟 The fear that resting will make everything fall apart
🌟 Putting on a brave face even when we’re overwhelmed
🌟 Constantly switching between tasks, feeling like we're barely holding things together

The fear of resting is real. We worry that if we stop, everything we’ve worked so hard to maintain will fall apart. Whether it’s at work, in relationships, or in everyday life, the pressure to keep going, to keep pushing, can be exhausting. It’s like carrying the weight of expectations that don’t fit who we are or how our brains work.

But it’s okay to pause. It’s okay to rest. You don’t always have to be ‘on’ to be enough.

Do you feel like you’re always ‘on’?

#ADHDLife
#ADHDStrength
#ADHDWarrior
#ResilientADHDer
#NeurodivergentPride
#ADHDWins
#CreativeMindset
#ADHDJourney
#ADHDAwareness
#ADHDSupport
#MentalHealthMatters
#ADHDCommunity
#LivingWithADHD
#EmbraceYourADHD
#NeurodivergentStrength
#BounceBackStronger
#ADHDInAdults
#OvercomeChallenges
#CreativeProblemSolving
#ThriveWithADHD". 

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neurodivers.show on Instagram: "ADHD masking is a way of coping that feels easier in the moment but does nothing to help us deal with what truly needs attention!

Which type of masking do you relate to?

-

Think you have ADHD or another neurological condition? 

We actually have a tool you can use to assess yourself before seeking an official diagnosis! Link in bio ✨"

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4,035 likes, 70 comments - neurodivers.show on September 3, 2024: "ADHD masking is a way of coping that feels easier in the moment but does nothing to help us deal with what truly needs attention!

Which type of masking do you relate to?

-

Think you have ADHD or another neurological condition? 

We actually have a tool you can use to assess yourself before seeking an official diagnosis! Link in bio ✨". 

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Molly brooks-dridge on Instagram: "Hey, Todays post is a new infographic all about Rejection sensitive dysphoria.. Something I’m very experienced with…

•RSD is informally used to describe intense emotional distress individuals may experience in response to rejection, perceived rejection, criticism, or failure to meet expectations.

•Subtle changes in someone’s tone or body language can trigger feelings of rejection and lead to significant reactions.

RSD is not a formal diagnosis and does not have a specific set of symptoms.

I’ve listed related behaviors and feelings (NOT LIMITED TO):

•Social withdrawal & isolation
•Self-critical
•Fear of failure
•Thought rumination
•Catastrophising the small things
•Perfectionism
•People pleasing

© I created these and they are covered by copy right, I would respect that you do not print them off, I ask you to respectfully donate to my link in my bio if you want a copy©

Please remember to like, comment, share and save!❤️❤️ 

Thankyou @mollys_adhd_mayhem 🌈

#adhd #adhdproblems #adhdwomen #adhdawareness #neurodivergent #explore #autism #adhdtiktok #tips #adhdsupport #adhdmemes #neurodivergentmemes #rejectionsensitivedysphoria #hypersensitivity #anxiety #socialanxiety #lonliness #actuallyautistic #autisticadults"

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mollys_adhd_mayhem on June 8, 2024: "Hey, Todays post is a new infographic all about Rejection sensitive dysphoria.. Something I’m very experienced with…

•RSD is informally used to describe intense emotional distress individuals may experience in response to rejection, perceived rejection, criticism, or failure to meet expectations.

•Subtle changes in someone’s tone or body language can trigger feelings of rejection and lead to significant reactions.

RSD is not a formal diagnosis and does not have a specific set of symptoms.

I’ve listed related behaviors and feelings (NOT LIMITED TO):

•Social withdrawal & isolation
•Self-critical
•Fear of failure
•Thought rumination
•Catastrophising the small things
•Perfectionism
•People pleasing

© I created these and they are covered by copy right, I would respect that you do not print them off, I ask you to respectfully donate to my link in my bio if you want a copy©

Please remember to like, comment, share and save!❤️❤️ 

Thankyou @mollys_adhd_mayhem 🌈

#adhd #adhdproblems #adhdwomen #adhdawareness #neurodivergent #explore #autism #adhdtiktok #tips #adhdsupport #adhdmemes #neurodivergentmemes #rejectionsensitivedysphoria #hypersensitivity #anxiety #socialanxiety #lonliness #actuallyautistic #autisticadults". 

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7 ways to be neurodiversity affirming flyer. Great parents, teachers, educators, therapists IEP team, and anyone with a autistic or neurodiverse child in their life!

Learn more about this item

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How to Be Neurodiversity Affirming - Etsy

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This Learning & School item by ABCsofAutism has 11 favorites from Etsy shoppers. Ships from United States. Listed on Jul 24, 2024

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216 likes, 7 comments - autism_mama_aus on August 17, 2024: "#autism #autismawareness #autismacceptance #asd #specialneeds #autistic #autismfamily  #autismspectrum #autismsupport  #autismspeaks #autismspectrumdisorder #autismparents #neurodiversity #inclusion #specialeducation #autismtraits #autismcharacteristics #sensory #understandingautism #neurodiversityaffirming". 

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I've expanded on the points listed in the image to help people understand what a Neurodiversity Affirming Practice or Approach is.

This is how I live my life; how I conduct myself with not only my own family and friends, but everyone I do business with. It is the foundation I work from, in all actions and interactions. I also believe each individual is capable of expressing their needs and advocating for themselves.

Neurodiversity Affirming Practice: This refers to an approach that recognizes and celebrates the natural variations in neurodevelopmental conditions, such as autism, ADHD, dyslexia, and others. It emphasizes the value of diverse neurological traits and rejects the notion of pathologizing or attempting to "normalize" individuals with neurodivergent characteristics.

The Core Principles: These principles serve as the foundation for neurodiversity affirming practice. They encompass a range of values and beliefs, including:

a. Intersectionality: Recognizing that individuals possess multiple social identities and experiences, such as gender, race, sexuality, disability, and class, which intersect and influence their lives. This principle emphasizes the need to consider these intersections when understanding and supporting neurodivergent individuals.

b. Respecting Autonomy: Respecting the self-determination and decision-making capabilities of neurodivergent individuals. This involves involving them in choices regarding their own lives, treatment options, and accommodations, while providing support and accessible information as needed.

c. Validating Differences: Acknowledging and accepting the differences in neurodivergent individuals, including their unique perspectives, communication styles, sensory experiences, and cognitive processes. This principle rejects the idea of defining normality based on neurotypical standards.

d. Presuming Competence: Assuming that neurodivergent individuals are capable, self-aware, and have valuable contributions to make, even if their abilities and strengths may manifest differently or require support.

e. Reframing Expectations: Challenging and shifting societal expectations and stereotypes related to neurodivergent individuals...

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What is a Neurodiversity Affirming Practice?

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Neurodiversity Affirming Practice: Core Principles, Intersectionality, Autonomy, and More | Learn about promoting inclusivity, respecting differences, and empowering neurodivergent individuals.

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Claire | Neuroinclusion on Instagram: "Which one do you most agree with?

The slides say:
1. A Commonly Forgotten Part of the Neurodiversity-Affirming Approach is being able to Differentiate Between Capacity Building and Compensation
2. It is not neurodiversity-affirming to teach resilience by denying their own experiences
3. Teaching Emotional Regulation and Executive Functioning Skills Should Never Come at the Cost of Burnout, Mental Health and Positive Sense of Self
4. Neurodiversity-Affirming Care is a Collaboration Where the Neurodivergent Person’s Perspectives Matters More Than Anyone Else’s

Compensation is just as therapeutic and valuable as developing a neurodivergent person’s capacity and skills to do daily tasks. When we are repeatedly taught something we cannot do, we are left feeling helpless, defeated and overwhelmed. These emotions are a recipe for burnout, mental health issues and a negative self-esteem. We must do more to accurately discuss and understand neurodivergent people’s abilities to best support their needs. Some days they may need to compensate and other days they may be able to develop more skills. 

An example of this for me personally is some days I can cook lunch for myself and other days, I do need to buy it. This is part of my fluctuating capacity. It doesn’t mean I can make lunch or I can’t. It is actually very complicated and we need more understanding to best support us at each stage of our functioning. 

What do you think? 

#disability #disabled #disabilityawareness #includion #celebratediversity #adhd #occupationaltherapy #livedexperience #actuallyautistic #adhdlife #adhdawareness"

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695 likes, 32 comments - neuroinclusion.au on August 7, 2024: "Which one do you most agree with?

The slides say:
1. A Commonly Forgotten Part of the Neurodiversity-Affirming Approach is being able to Differentiate Between Capacity Building and Compensation
2. It is not neurodiversity-affirming to teach resilience by denying their own experiences
3. Teaching Emotional Regulation and Executive Functioning Skills Should Never Come at the Cost of Burnout, Mental Health and Positive Sense of Self
4. Neurodiversity-Affirming Care is a Collaboration Where the Neurodivergent Person’s Perspectives Matters More Than Anyone Else’s

Compensation is just as therapeutic and valuable as developing a neurodivergent person’s capacity and skills to do daily tasks. When we are repeatedly taught something we cannot do, we are left feeling helpless, defeated and overwhelmed. These emotions are a recipe for burnout, mental health issues and a negative self-esteem. We must do more to accurately discuss and understand neurodivergent people’s abilities to best support their needs. Some days they may need to compensate and other days they may be able to develop more skills. 

An example of this for me personally is some days I can cook lunch for myself and other days, I do need to buy it. This is part of my fluctuating capacity. It doesn’t mean I can make lunch or I can’t. It is actually very complicated and we need more understanding to best support us at each stage of our functioning. 

What do you think? 

#disability #disabled #disabilityawareness #includion #celebratediversity #adhd #occupationaltherapy #livedexperience #actuallyautistic #adhdlife #adhdawareness". 

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Method Creative on Instagram: "Because designing for the NEUROCOMPLEX is designing for ALL✌️🌀
.
🤘Lindsey + Penny
.
#neurodivergent #neurodiversity #neuroinclusive #workplacedesign #workplacewellness #workplaceculture #dei #neuroinclusion #adhdawareness #autismawareness #audhd #sensory #gifted #giftedtrauma #twiceexceptional #2e
#autistic #AutismAssessment #ActuallyAutistic #AuDHD#autisticadults"

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304 likes, 2 comments - method.creative.mpls on August 20, 2024: "Because designing for the NEUROCOMPLEX is designing for ALL✌️🌀
.
🤘Lindsey + Penny
.
#neurodivergent #neurodiversity #neuroinclusive #workplacedesign #workplacewellness #workplaceculture #dei #neuroinclusion #adhdawareness #autismawareness #audhd #sensory #gifted #giftedtrauma #twiceexceptional #2e
#autistic #AutismAssessment #ActuallyAutistic #AuDHD#autisticadults". 

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Steph Robertson on Instagram: "✨Neurodivergence and fluctuating capacity.✨

Many neurodivergent conditions are dynamic disabilities which means they often have fluctuating presentations. This can lead to a lot of misunderstandings about the support needs of the individual. 
Fluctuating capacity refers to the variability in an individual’s ability to perform tasks in all areas of life. 
Sometimes we may be able to do something, and then later we can’t.
Capacity can fluctuate over the course of a day, hour, or even minute.

Some things that can influence capacity include-

Energy levels: a person’s  capacity to engage in activities can vary greatly depending on energy levels. The Spoon Theory is often used as a way to measure of pace capacity.

Spiky Profile: People may excel in some areas, while having significant challenges in other areas. This can lead to unfair expectations being places on people. It can lead to incredible masking where the struggle of these individuals is invisible and therefore, not validated or supported. Awareness of strengths and challenges is important when supporting capacity. 

Environmental Demands: the balance between environmental demands and an individual’s capacity can change rapidly. This dynamic can significantly impact their ability to function in different situations.

Sensory influences: either internal or external, can have a big influence on someone’s capacity across all environments.

*This is not an exhausted list!

It’s okay on the days you can and it’s okay on the days you can’t. Your experiences and support needs are always valid. 🥰

ID: 6 images on beige background. All test on slides is included in the caption above. The slides contain dark blue writing and some have coloured boxes around them. Slide 5 includes a graph showing what a spiky profile may look like and slide 6 has a picture of Steph."

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1,673 likes, 22 comments - sgroccupationaltherapy on August 12, 2024: "✨Neurodivergence and fluctuating capacity.✨

Many neurodivergent conditions are dynamic disabilities which means they often have fluctuating presentations. This can lead to a lot of misunderstandings about the support needs of the individual. 
Fluctuating capacity refers to the variability in an individual’s ability to perform tasks in all areas of life. 
Sometimes we may be able to do something, and then later we can’t.
Capacity can fluctuate over the course of a day, hour, or even minute.

Some things that can influence capacity include-

Energy levels: a person’s  capacity to engage in activities can vary greatly depending on energy levels. The Spoon Theory is often used as a way to measure of pace capacity.

Spiky Profile: People may excel in some areas, while having significant challenges in other areas. This can lead to unfair expectations being places on people. It can lead to incredible masking where the struggle of these individuals is invisible and therefore, not validated or supported. Awareness of strengths and challenges is important when supporting capacity. 

Environmental Demands: the balance between environmental demands and an individual’s capacity can change rapidly. This dynamic can significantly impact their ability to function in different situations.

Sensory influences: either internal or external, can have a big influence on someone’s capacity across all environments.

*This is not an exhausted list!

It’s okay on the days you can and it’s okay on the days you can’t. Your experiences and support needs are always valid. 🥰

ID: 6 images on beige background. All test on slides is included in the caption above. The slides contain dark blue writing and some have coloured boxes around them. Slide 5 includes a graph showing what a spiky profile may look like and slide 6 has a picture of Steph.". 

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ADHD & Autism are not "highly overlapping"

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ADHD & Autism are not "highly overlapping"

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Amanda Moses Psychology on Instagram: "There is a difference between two things that often come in pairs, and two things that are similar. Autism and ADHD couldn’t be more different, let’s not confuse them.

#autism #adhd #autismawareness #neurotype #neurodivergent #psychologist"

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1,289 likes, 149 comments - amandamosespsychology on August 12, 2024: "There is a difference between two things that often come in pairs, and two things that are similar. Autism and ADHD couldn’t be more different, let’s not confuse them.

#autism #adhd #autismawareness #neurotype #neurodivergent #psychologist". 

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ADHD Mom Coach | Amy Marie Hann on Instagram: "The secret to learning to thrive with ADHD is understanding how to manage your executive function challenges.

When we understand that these challenges aren’t character flaws but actual brain based challenges, we can find and implement solutions to help lower the mental load of our daily life.

Things like planning, prioritizing, decision making, time management, organizing… these can be challenging and extra draining for us so we need solutions that help us to do less of this on a daily basis.

And no, just having a plan isn’t enough because you WILL forget that plan when you need it most.

For me, visuals are hugely helpful and I have them everywhere. One tool or planner isn’t enough and for me, visuals really help me to understand my life and priorities.

I’ve created literally hundreds of tools over the years but only share what actually works over time and has been helpful to others too. Because what good is a cute template if it doesn’t actually help make my daily life easier?!?

My MTM E-book and Canva template pack is my tried and true staples for managing my home and family and you can get access to it but commenting SYSTEM. 

Got another EF hack?! Share it below! ⤵️
.
.
.
.
.
#adhdmom #adhdlife #adhdadult #momswithadhd #executivefunctioning #mentalhealth #adhdsupport"

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231 likes, 81 comments - activatedadhdmama on August 8, 2024: "The secret to learning to thrive with ADHD is understanding how to manage your executive function challenges.

When we understand that these challenges aren’t character flaws but actual brain based challenges, we can find and implement solutions to help lower the mental load of our daily life.

Things like planning, prioritizing, decision making, time management, organizing… these can be challenging and extra draining for us so we need solutions that help us to do less of this on a daily basis.

And no, just having a plan isn’t enough because you WILL forget that plan when you need it most.

For me, visuals are hugely helpful and I have them everywhere. One tool or planner isn’t enough and for me, visuals really help me to understand my life and priorities.

I’ve created literally hundreds of tools over the years but only share what actually works over time and has been helpful to others too. Because what good is a cute template if it doesn’t actually help make my daily life easier?!?

My MTM E-book and Canva template pack is my tried and true staples for managing my home and family and you can get access to it but commenting SYSTEM. 

Got another EF hack?! Share it below! ⤵️
.
.
.
.
.
#adhdmom #adhdlife #adhdadult #momswithadhd #executivefunctioning #mentalhealth #adhdsupport". 

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How to support someone during a meltdown

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How to support someone during a meltdown

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Claire | Neuroinclusion on Instagram: "What do you do when a neurodivergent person experiences a meltdown?

I strongly recommend these four things:

1️⃣Provide a Safe Space
Having a safe physical environment is one of the best ways to support someone who is having a meltdown. This may look like removing sharp objects like scissors from the room, providing pillows and soft objects to protect yourself and items and removing other people from the area. 

2️⃣ Reduce Sensory Inputs
Often neurodivergent people experience sensory overload. This can trigger a meltdown and be hard to articulate. During a meltdown, it’s important to not add any more sensations for our brains to process. Regardless of how well intentioned it may be, additional sensations make the meltdown last longer

3️⃣ Support the expression
Expressing our truest and deepest emotions is something we all need to do. Being compassionate and acknowledging the challenges we face as neurodivergent individuals in a neuronormative world, is key. Having the time and space to express ourselves is crucial for our health.

4️⃣ Facilitate Co-regulation
We need to understand and value co-regulation as a vital part of reducing the duration and severity of meltdowns for neurodivergent people. Our presence alone is a powerful support to someone who is dysregulated. We are able to share our own regulation with them. Managing our own regulation near someone who is dysregulated is difficult, but very powerful

#coregulation #selfregulation #emotionalregulation #meltdown #autistic #adhd #neurodivergent #neurodiversity #tantrum #emotional #emotions"

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1,003 likes, 39 comments - neuroinclusion.au on August 11, 2024: "What do you do when a neurodivergent person experiences a meltdown?

I strongly recommend these four things:

1️⃣Provide a Safe Space
Having a safe physical environment is one of the best ways to support someone who is having a meltdown. This may look like removing sharp objects like scissors from the room, providing pillows and soft objects to protect yourself and items and removing other people from the area. 

2️⃣ Reduce Sensory Inputs
Often neurodivergent people experience sensory overload. This can trigger a meltdown and be hard to articulate. During a meltdown, it’s important to not add any more sensations for our brains to process. Regardless of how well intentioned it may be, additional sensations make the meltdown last longer

3️⃣ Support the expression
Expressing our truest and deepest emotions is something we all need to do. Being compassionate and acknowledging the challenges we face as neurodivergent individuals in a neuronormative world, is key. Having the time and space to express ourselves is crucial for our health.

4️⃣ Facilitate Co-regulation
We need to understand and value co-regulation as a vital part of reducing the duration and severity of meltdowns for neurodivergent people. Our presence alone is a powerful support to someone who is dysregulated. We are able to share our own regulation with them. Managing our own regulation near someone who is dysregulated is difficult, but very powerful

#coregulation #selfregulation #emotionalregulation #meltdown #autistic #adhd #neurodivergent #neurodiversity #tantrum #emotional #emotions". 

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I Go to Therapy on Instagram: "🍓 This is by no means a diagnostic tool - and experiencing some of these things occasionally can be perfectly normal and unrelated to ADHD. However, consistently experiencing symptoms of hyperactivity, inattention, and trouble regulating your attention throughout your life might warrant further investigation into ADHD.
⠀⠀⠀ ⠀⠀⠀⠀⠀ 
🍓 Recent research has found that ADHD can sometimes present differently in men vs women, which can explain the lower rates of diagnosis & later diagnosis in women compared to men. While exceptions of course occur, and men can have inattentive ADHD just like women can have ADHD that primarily consists of hyperactivity and impulsivity, women have been found to be more likely to have ADHD that shows up as inattentiveness, mental hyperactivity, and ‘spacing out’, while among men and boys it’s more common to see disruptiveness, visible hyperactivity, and risky behaviors.
⠀⠀⠀⠀⠀⠀⠀⠀⠀
🍓 While ADHD can come with several challenges, it’s important to know that you aren’t flawed, broken, or wrong - you’re  just wired differently, and understanding what may be due to ADHD can help with finding suitable coping mechanisms, self-awareness and self-understanding, and ways of embracing your unique qualities.
⠀⠀⠀⠀⠀⠀⠀⠀⠀
————————
🧠 check out our bio for mental health resources and to find a therapist.

⠀⠀⠀⠀⠀⠀⠀⠀"

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22K likes, 171 comments - igototherapy on August 4, 2024: "🍓 This is by no means a diagnostic tool - and experiencing some of these things occasionally can be perfectly normal and unrelated to ADHD. However, consistently experiencing symptoms of hyperactivity, inattention, and trouble regulating your attention throughout your life might warrant further investigation into ADHD.
⠀⠀⠀ ⠀⠀⠀⠀⠀ 
🍓 Recent research has found that ADHD can sometimes present differently in men vs women, which can explain the lower rates of diagnosis & later diagnosis in women compared to men. While exceptions of course occur, and men can have inattentive ADHD just like women can have ADHD that primarily consists of hyperactivity and impulsivity, women have been found to be more likely to have ADHD that shows up as inattentiveness, mental hyperactivity, and ‘spacing out’, while among men and boys it’s more common to see disruptiveness, visible hyperactivity, and risky behaviors.
⠀⠀⠀⠀⠀⠀⠀⠀⠀
🍓 While ADHD can come with several challenges, it’s important to know that you aren’t flawed, broken, or wrong - you’re  just wired differently, and understanding what may be due to ADHD can help with finding suitable coping mechanisms, self-awareness and self-understanding, and ways of embracing your unique qualities.
⠀⠀⠀⠀⠀⠀⠀⠀⠀
————————
🧠 check out our bio for mental health resources and to find a therapist.

⠀⠀⠀⠀⠀⠀⠀⠀". 

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The Adhd Elites on Instagram: "Do you agree?
Can you relate?
Credit:@adhdjesse
Follow us @adhdelite
.
.
.
.
#adhd #adhdmemes #adhdproblems #adhdawareness #adhdparenting #adhdsupport #adhdwomen #adhdlife #adhdbrain #adhdtips #adhdmom #adhdkids #add #ocd #mentalhealth #mentalhealthmatters #mentalhealthawareness #neurodivergent"

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18K likes, 156 comments - adhdelite on April 18, 2024: "Do you agree?
Can you relate?
Credit:@adhdjesse
Follow us @adhdelite
.
.
.
.
#adhd #adhdmemes #adhdproblems #adhdawareness #adhdparenting #adhdsupport #adhdwomen #adhdlife #adhdbrain #adhdtips #adhdmom #adhdkids #add #ocd #mentalhealth #mentalhealthmatters #mentalhealthawareness #neurodivergent". 

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Brooke Schnittman | ADHD Coach on Instagram: "What makes ADHDers procrastinate?

ADHD Procrastination is very often driven by intense negative emotions.

Become a master of beating procrastination with one of our experienced & certified ADHD Coaches

Comment "READY" for the link to learn more in your DMs 

#adhd #adhdcoach #adhdproblems #adhdawareness #adhdwomen #adhdbrain"

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4,547 likes, 60 comments - coachingwithbrooke on April 1, 2024: "What makes ADHDers procrastinate?

ADHD Procrastination is very often driven by intense negative emotions.

Become a master of beating procrastination with one of our experienced & certified ADHD Coaches

Comment "READY" for the link to learn more in your DMs 

#adhd #adhdcoach #adhdproblems #adhdawareness #adhdwomen #adhdbrain". 

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Dr. Michaela  | Registered Clinical Psychologist | Author on Instagram: "Is this you?? Let me know in the comments⁠
⁠
If you struggle with anxious, self-critical, racing thoughts and consider yourself an overthinker then don’t worry..I’ve got you...Check out the overthinking toolkit...LINK IN BIO ⁠
⁠
🗣❤️ Tag a friend too, lets spread some easy therapy.⁠
⁠
#⁠selflovecoach #overthinking⁠
#acceptaceandcommitment⁠
#feelyouremotions⁠ #achieveyourgoals ⁠
#dontgiveupquotes⁠ #londonpsychologist⁠
#psychologist #cuteillustration⁠
#motivationalquoteoftheday⁠
#therapymemes⁠ #selfhelper⁠
#therapyquotes⁠ #positiveqoutes⁠
#affirmationoftheday⁠
#powerofthought #unhook⁠
#mentalhealblogger #dontjudge⁠
#mentalhealthtips #positivity⁠
#positivequotestoday #therapistproblems ⁠
#negativethoughts #anxiety⁠
#thinking #acceptanceandcommitment⁠therapy⁠
#mindfulness⁠ #manifestingdreams⁠
#Easytherapy ⁠"

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myeasytherapy on March 21, 2024: "Is this you?? Let me know in the comments⁠
⁠
If you struggle with anxious, self-critical, racing thoughts and consider yourself an overthinker then don’t worry..I’ve got you...Check out the overthinking toolkit...LINK IN BIO ⁠
⁠
🗣❤️ Tag a friend too, lets spread some easy therapy.⁠
⁠
#⁠selflovecoach #overthinking⁠
#acceptaceandcommitment⁠
#feelyouremotions⁠ #achieveyourgoals ⁠
#dontgiveupquotes⁠ #londonpsychologist⁠
#psychologist #cuteillustration⁠
#motivationalquoteoftheday⁠
#therapymemes⁠ #selfhelper⁠
#therapyquotes⁠ #positiveqoutes⁠
#affirmationoftheday⁠
#powerofthought #unhook⁠
#mentalhealblogger #dontjudge⁠
#mentalhealthtips #positivity⁠
#positivequotestoday #therapistproblems ⁠
#negativethoughts #anxiety⁠
#thinking #acceptanceandcommitment⁠therapy⁠
#mindfulness⁠ #manifestingdreams⁠
#Easytherapy ⁠". 

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A post shared by Dr. Michaela | Registered Clinical Psychologist | Author (@myeasytherapy)

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ADHD Chatter Podcast on Instagram: "Rejection sensitive Dysphoria explained. Tap ❤️ if you relate!

#adhdawareness #neurodivergent #adhdproblems"

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475K likes, 4,012 comments - adhd_chatter_podcast on December 1, 2023: "Rejection sensitive Dysphoria explained. Tap ❤️ if you relate!

#adhdawareness #neurodivergent #adhdproblems". 

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Work culture & accommodations people look for as neurodivergents

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Work culture & accommodations people look for as neurodivergents

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Much Much Spectrum - Home to the Wholesome on Instagram: "Wondering how to make your workplace inclusive and accommodating for neurodivergent employees? 

DM us or write to us at partnerships@muchmuchmedia.com to learn more 

Join the conversation @muchmuchspectrum 

#MuchMuchSays is where we ask our community about their #LivedExperience 

#WorkplaceWellness #WorkplaceCulture #Neurodiverse #Neurodiversity #Neurodivergent #Neurodivergence #AutismAcceptance #AutismAdvocate #DiversityEquityInclusion #WorkplaceInclusion #AutismInclusion #ADHD #Dyslexia #MuchMuchSpectrum"

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2,002 likes, 27 comments - muchmuchspectrum on November 6, 2023: "Wondering how to make your workplace inclusive and accommodating for neurodivergent employees? 

DM us or write to us at partnerships@muchmuchmedia.com to learn more 

Join the conversation @muchmuchspectrum 

#MuchMuchSays is where we ask our community about their #LivedExperience 

#WorkplaceWellness #WorkplaceCulture #Neurodiverse #Neurodiversity #Neurodivergent #Neurodivergence #AutismAcceptance #AutismAdvocate #DiversityEquityInclusion #WorkplaceInclusion #AutismInclusion #ADHD #Dyslexia #MuchMuchSpectrum". 

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6 templates for requesting reasonable adjustments as an Autistic employee

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6 templates for requesting reasonable adjustments as an Autistic employee

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Happy Autistic Lady on Instagram: "Do you even know how to ask for reasonable adjustments at work?

Employers are legally required to provide “reasonable adjustments” to make sure workers with disabilities, or physical or mental health conditions, are not substantially disadvantaged when doing their jobs.

But asking for reasonable adjustments can be daunting.

🤷‍♀️ How are you meant to know which adjustments you might find helpful in the first place, and how should you even formulate your request?

⬆️ This is a list of reasonable adjustments and suggestions on how to ask for them.

Save this post as a template for asking for reasonable adjustments ⬆️ You deserve to be accommodated!

#AutismSale #Neurodivergent #autism #SensoryProcessingDisorder #AutismSpeaks #autismproud #autismawareness #autismjourney #Disbaled #ADHD #SensoryProcessing #ActuallyAutistic #ASD #AutismAcceptance #autismcommunity #DisabilityOwnedBusiness #disabilityawareness #AutismSpectrum #autismlife #neurodiversity #Autistic #autismsupport #Autismo #AutisticWomen #Autista #AutismPride #NonVerbalAutism #DisabilityOwned #autismadvocate #SupportAutism"

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1,309 likes, 9 comments - happyautisticlady on November 18, 2023: "Do you even know how to ask for reasonable adjustments at work?

Employers are legally required to provide “reasonable adjustments” to make sure workers with disabilities, or physical or mental health conditions, are not substantially disadvantaged when doing their jobs.

But asking for reasonable adjustments can be daunting.

🤷‍♀️ How are you meant to know which adjustments you might find helpful in the first place, and how should you even formulate your request?

⬆️ This is a list of reasonable adjustments and suggestions on how to ask for them.

Save this post as a template for asking for reasonable adjustments ⬆️ You deserve to be accommodated!

#AutismSale #Neurodivergent #autism #SensoryProcessingDisorder #AutismSpeaks #autismproud #autismawareness #autismjourney #Disbaled #ADHD #SensoryProcessing #ActuallyAutistic #ASD #AutismAcceptance #autismcommunity #DisabilityOwnedBusiness #disabilityawareness #AutismSpectrum #autismlife #neurodiversity #Autistic #autismsupport #Autismo #AutisticWomen #Autista #AutismPride #NonVerbalAutism #DisabilityOwned #autismadvocate #SupportAutism". 

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A post shared by Happy Autistic Lady (@happyautisticlady)

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Briana Plyler || ADHD Coach on Instagram: "I used too many slides so head to stories to see a bonus slide with sample language. 

Let me know if these are helpful! What possible barriers did I miss? 

What tips or tricks can you add? 

#protiptuesday #adhd #adhdcoach"

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1,211 likes, 24 comments - currentadhdcoaching on September 12, 2023: "I used too many slides so head to stories to see a bonus slide with sample language. 

Let me know if these are helpful! What possible barriers did I miss? 

What tips or tricks can you add? 

#protiptuesday #adhd #adhdcoach". 

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A post shared by Briana Plyler || ADHD Coach (@currentadhdcoaching)

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How do people with ADHD think? Convergent vs. divergent thinking

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How do people with ADHD think? Convergent vs. divergent thinking

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Skye Waterson, MA. - Focused, Balanced Days with ADHD on Instagram: "How do people with ADHD think?

The brainstorming phase of a project is often your favourite, as you find it easy to let your mind wander and come up with new ideas.

At the conclusion and implementation stage, however, you have difficulty focusing on getting the final touches right, with strict control necessary to prevent your mind jumping to other topics.

➡️If you can relate to this, click the link in our bio to find out more!

#adhd #adhdtips #adhdstrategies #adhdcoach #adhdcoaching #add #adhdproblems #adhdchallenges #adhdsupport #adhdfamily #adhdlife #adhdbrain #adhdburnout #burnout #adhdfacts #adhdresearch #adhdmanagement #neurodiverse #neurodiversity #adhdhack #adhdinfo #adhdtips"

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4,476 likes, 42 comments - unconventionalorganisation on February 16, 2023: "How do people with ADHD think?

The brainstorming phase of a project is often your favourite, as you find it easy to let your mind wander and come up with new ideas.

At the conclusion and implementation stage, however, you have difficulty focusing on getting the final touches right, with strict control necessary to prevent your mind jumping to other topics.

➡️If you can relate to this, click the link in our bio to find out more!

#adhd #adhdtips #adhdstrategies #adhdcoach #adhdcoaching #add #adhdproblems #adhdchallenges #adhdsupport #adhdfamily #adhdlife #adhdbrain #adhdburnout #burnout #adhdfacts #adhdresearch #adhdmanagement #neurodiverse #neurodiversity #adhdhack #adhdinfo #adhdtips". 

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A post shared by Skye Waterson, MA. - Focused, Balanced Days with ADHD (@unconventionalorganisation)

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Olivia Lutfallah on Instagram: "ADHD Paralysis Explained #adhd"

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715K likes, 3,794 comments - olivialutfallah on October 23, 2022: "ADHD Paralysis Explained #adhd". 

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A post shared by Olivia Lutfallah (@olivialutfallah)

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Skye Waterson, MA. - Focused, Balanced Days with ADHD on Instagram: "The work environment is often not very suitable for ADHD individuals. Swipe to see some  challenges that ADHD individuals encounter in the workplace!

What is your biggest workplace challenge?

➡️Click the link in our bio to read the full article!

 #adhdcommunity #adhdlifehacks #adhdhacks #adhd #adhd2022 #adhdworld #adhdsupport #adhdtips #adhdhack #adhdjourney #adhdcoach #adhdfamily #adhdenterpreneur #adhdhelp #adhdbrain #adhdwoman #adhdproblems #adhdman #adhdisreal #adhdtribe #adhdmanagement"

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3,992 likes, 106 comments - unconventionalorganisation on April 7, 2022: "The work environment is often not very suitable for ADHD individuals. Swipe to see some  challenges that ADHD individuals encounter in the workplace!

What is your biggest workplace challenge?

➡️Click the link in our bio to read the full article!

 #adhdcommunity #adhdlifehacks #adhdhacks #adhd #adhd2022 #adhdworld #adhdsupport #adhdtips #adhdhack #adhdjourney #adhdcoach #adhdfamily #adhdenterpreneur #adhdhelp #adhdbrain #adhdwoman #adhdproblems #adhdman #adhdisreal #adhdtribe #adhdmanagement". 

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What is it like to have ADHD? An animation

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What is it like to have ADHD? An animation

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ADHDoers on Instagram: "Not me crying when the girl spoke

—

SUPER SUMMER SALE 95% OFF

ON THE EVERYTHING NEURODIVERGENT BUNDLE! 

42 ebooks, workbooks & webinars to help with : 

- nutrition 
- ⁠assessing ADHD & Autism 
- ⁠Sleep
- ⁠organization at home & in general
- ⁠productivity 
- ⁠managing ADHD for children and adults 
- ⁠and many more Link in bio ✨ ( email us if you can’t afford something ) 

—

Where to watch the full video:
Video title: What’s it like to have ADHD?
YouTube channel’s name: ADHDVOICES"

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6,851 likes, 66 comments - adhdoers on July 31, 2024: "Not me crying when the girl spoke

—

SUPER SUMMER SALE 95% OFF

ON THE EVERYTHING NEURODIVERGENT BUNDLE! 

42 ebooks, workbooks & webinars to help with : 

- nutrition 
- ⁠assessing ADHD & Autism 
- ⁠Sleep
- ⁠organization at home & in general
- ⁠productivity 
- ⁠managing ADHD for children and adults 
- ⁠and many more Link in bio ✨ ( email us if you can’t afford something ) 

—

Where to watch the full video:
Video title: What’s it like to have ADHD?
YouTube channel’s name: ADHDVOICES". 

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A post shared by ADHDoers (@adhdoers)

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Sheila Henson on Instagram: "Squirrel Team is a way to make ADHD Coaching more affordable and accessible, and to connect ADHDers to others who understand their unique brains.⁠
⁠
Join us Sundays from 4pm-5:30pm PT for 8 weeks (June 23 - August 11, 2024) to learn skills and tools that will help you navigate your ADHD and learn to love your ADHD brain.⁠
⁠
The group chooses the topics we cover, but some common topics are:⁠
⁠
- executive dysfunction⁠
- stress reduction⁠
- self advocacy⁠
- time management⁠
- organizing⁠
- boundaries⁠
- how to rest⁠
- identifying needs⁠
- tools for memory⁠
- utilizing your strengths⁠
- and more!⁠
⁠
Tiered pricing is available. Sign up for Squirrel Team today at sheilahenson.com/events! ⁠
⁠
***********⁠
⁠
#adhd #squirrelteam #groupcoaching #adhdgroupcoaching #adhdcoach #adhdsupport #executivedysfunction #stressreduction #selfadvocacy #timemanagement #organizing #boundaries #rest #identifyingneeds #productivity #memory⁠"

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561 likes, 3 comments - adhdcoachsheila on June 12, 2024: "Squirrel Team is a way to make ADHD Coaching more affordable and accessible, and to connect ADHDers to others who understand their unique brains.⁠
⁠
Join us Sundays from 4pm-5:30pm PT for 8 weeks (June 23 - August 11, 2024) to learn skills and tools that will help you navigate your ADHD and learn to love your ADHD brain.⁠
⁠
The group chooses the topics we cover, but some common topics are:⁠
⁠
- executive dysfunction⁠
- stress reduction⁠
- self advocacy⁠
- time management⁠
- organizing⁠
- boundaries⁠
- how to rest⁠
- identifying needs⁠
- tools for memory⁠
- utilizing your strengths⁠
- and more!⁠
⁠
Tiered pricing is available. Sign up for Squirrel Team today at sheilahenson.com/events! ⁠
⁠
***********⁠
⁠
#adhd #squirrelteam #groupcoaching #adhdgroupcoaching #adhdcoach #adhdsupport #executivedysfunction #stressreduction #selfadvocacy #timemanagement #organizing #boundaries #rest #identifyingneeds #productivity #memory⁠". 

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Kelly on Instagram: "Same goes for how you talk to yourself ❤️
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#adhd #audhd #neurodivergent #adhdawareness #adhdmemes #adhdwomen #adhdsupport #adhdbrain"

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117K likes, 1,004 comments - divergentcoachkelly on May 4, 2024: "Same goes for how you talk to yourself ❤️
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#adhd #audhd #neurodivergent #adhdawareness #adhdmemes #adhdwomen #adhdsupport #adhdbrain". ADHD, Psa, tough love, shaming, compassion

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Meredith Carder | ADHD Coach on Instagram: "Before my ADHD diagnosis I was baffled by the fact that I was incredible in a crisis or managing a “high energy” event….but would  fall apart when the little unexpected demands piled up. 

The more I understood about ADHD the more it made sense and I was able to put in place coping strategies that have made a huge difference. I share more strategies in my book "It All Makes Sense Now". Comment "link" and I'll DM you the link to grab your copy.

What unexpected requests cause max frustration for you?

#adhd #adhdproblems #adhdstruggles #adhdbrain #adultadhd #adhdawareness #adhdwoman"

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1,243 likes, 17 comments - hummingbird_adhd on September 23, 2024: "Before my ADHD diagnosis I was baffled by the fact that I was incredible in a crisis or managing a “high energy” event….but would  fall apart when the little unexpected demands piled up. 

The more I understood about ADHD the more it made sense and I was able to put in place coping strategies that have made a huge difference. I share more strategies in my book "It All Makes Sense Now". Comment "link" and I'll DM you the link to grab your copy.

What unexpected requests cause max frustration for you?

#adhd #adhdproblems #adhdstruggles #adhdbrain #adultadhd #adhdawareness #adhdwoman". 

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A post shared by Meredith Carder | ADHD Coach (@hummingbird_adhd)

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Ingri | Certified ADHD Coach✨🧠 on Instagram: "Small tasks often seem dreadful. When for other people it’s “just 10 minutes of work”, for me it feels like “forever”.  It can make it difficult to start, as I often can build myself up for forever lasting boredom. And who wants that?! 😅☠️

Realising that time blindness plays such a HUGE role in this, has been so helpful!
⏰ The analog timer helps me see the passage of time, and it’s much easier to get started.
🏆 Also, making these tasks more challenging, exciting or rewarding works like a charm. 
- How much can I get done in five minutes?
- Who can do this task faster? Me or my partner?
- Oh, that podcast I wanted to listen to? I’ll enjoy it while doing the laundry. 
- What is motivating me to do this task?
- Turning tasks into a game: writing down chores on small pieces of paper, putting them in a jar and drawing them out one at a time. Also removes the pressure to do it all at once. 😊

💬 what tips do you have to avoid the “forever void”? 😊
-

📚 ADHD & Overwhelm workbook is available on Etsy. Please see the link in bio. ✨
-
#adhd #adhdawareness #adhdwomen #neurodiversity #neurodivergent #adhdmemes #adhdcoach #adhdparenting"

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6,376 likes, 38 comments - adhd_couple on August 27, 2024: "Small tasks often seem dreadful. When for other people it’s “just 10 minutes of work”, for me it feels like “forever”.  It can make it difficult to start, as I often can build myself up for forever lasting boredom. And who wants that?! 😅☠️

Realising that time blindness plays such a HUGE role in this, has been so helpful!
⏰ The analog timer helps me see the passage of time, and it’s much easier to get started.
🏆 Also, making these tasks more challenging, exciting or rewarding works like a charm. 
- How much can I get done in five minutes?
- Who can do this task faster? Me or my partner?
- Oh, that podcast I wanted to listen to? I’ll enjoy it while doing the laundry. 
- What is motivating me to do this task?
- Turning tasks into a game: writing down chores on small pieces of paper, putting them in a jar and drawing them out one at a time. Also removes the pressure to do it all at once. 😊

💬 what tips do you have to avoid the “forever void”? 😊
-

📚 ADHD & Overwhelm workbook is available on Etsy. Please see the link in bio. ✨
-
#adhd #adhdawareness #adhdwomen #neurodiversity #neurodivergent #adhdmemes #adhdcoach #adhdparenting". 

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RSD can actually lead to having ADHD superpowers

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RSD can actually lead to having ADHD superpowers