By Beth Levine

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

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

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

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

Which Comes First — Stress or ADHD?

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

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

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

Taming the Stress Monster

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

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

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

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

• Get moving

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

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

• Think small

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

• Control your technology

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

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

• Create transition times

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

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

• Establish a routine

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

• Write it down

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

• Stop judging yourself

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

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

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

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

• Meditation and mindfulness

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

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

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

• Do relaxation training

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

• Practice makes better … not perfect

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

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