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Procrastination isn’t laziness; it’s often a neurological struggle with motivation, memory, time and emotion. In this short practical guide, our founder, psychotherapist, ADHD coach and counsellor Duncan E. Stafford unpacks the hidden mechanisms of ADHD procrastination and shares how therapy and coaching might help to navigate each one. From task initiation to emotional overwhelm, this blog offers insight and direction for those living with ADHD and the people who support them.

(8 minute read)

1. Getting tasks started: The struggle to begin

The problem: You know what you need to do, but you just can’t seem to start.

What’s happening: ADHD may involve difficulty switching between the brain’s default mode network (DMN) – which is active during rest, mind-wandering and internal thought – and the executive control network – which supports focus and task completion. Neuroimaging studies suggest that people with ADHD often show reduced suppression of the DMN during goal-directed tasks. In effect, the ADHD brain can get “stuck” in the DMN, making it hard to transition into action – especially without external pressure, novelty or stimulation. Research in this area is still evolving, but it offers promising insights into the neural roots of ADHD-related procrastination.

Result: You find yourself caught in “I’ll do it later” cycles – even for simple or urgent tasks.

Therapy and coaching helps: One early strategy is to start small. With your therapist or coach, choose a task that’s stuck (e.g. clearing part of a room) or set a micro-goal (e.g. sending a daily text message as a log of progress). These small starts help to build momentum and support your task initiation skills.

 

2. Tick, tock, time passes without you …

The problem: You underestimate how long tasks take, or you lose track of time entirely.

What’s happening: This is often described as time blindness, a well-recognised trait in many people with ADHD. Time isn’t easily felt internally – there’s a reduced sense of how long things actually take or how much time is passing. Without this intuitive awareness, it’s harder to pace yourself, anticipate deadlines or feel urgency until the pressure becomes overwhelming or too late to act.

Result: Tasks are started too late, rushed in a panic or missed altogether.

Therapy and coaching helps: Working with a coach or therapist, you can co-design practical tools for breaking tasks into smaller steps, then timing how long each step takes. Starting with just one task avoids overload. You might also learn to recognise how time drifts away – even within the structure of a session – so you can begin noticing and managing it more intentionally.

 

3. Distraction control: The pull of everything else

The problem: You start a task, but your attention quickly drifts – either to your thoughts, your phone or anything more stimulating around you. Sometimes, this happens when your brain hasn’t fully shifted out of the DMN, which can undermine focus.

What’s happening: ADHD has been associated with lower, fluctuating or imbalanced dopamine levels. This impacts motivation and reward sensitivity, making novel or highly stimulating distractions especially hard to resist. Difficulties with neural switching delays and executive dysfunction further weaken sustained attention and the ability to stay on-task, especially when the task lacks immediate reward or novelty.

Result: Tasks are delayed, paused or dropped entirely. It’s less about willpower and more about how your brain processes attention and reward.

Therapy and coaching helps: While dopamine imbalance plays a role, interest-based motivation is equally important (see section 5). Coaching and therapy can help you to explore what holds your attention and why some tasks lose meaning quickly. So, it’s not about willpower, but more often about desire, relevance and emotional engagement.

 

4. Planning and structure: Where’s the roadmap?

The problem: You struggle to break down or sequence tasks clearly.

What’s happening: ADHD is often associated with impairments in working memory (also known as short-term memory), which is your brain’s ability to temporarily hold and manipulate information. When working memory is compromised, it becomes harder to plan, organise and juggle the steps involved in completing a task. This can make sequencing feel unclear and/or overwhelming.

Result: Tasks that seem straightforward to others can feel too big, vague or chaotic. Even if you’re motivated, the lack of internal structure can lead to overload, avoidance or shutdown.

Therapy and coaching helps: For ADHDers affected by working memory challenges, learning to “chunk” or break tasks into small manageable steps is essential. For example, rather than tackling “Decorate the living room”, break it into specific actions – e.g. “Pick a paint colour”, “Clear the furniture” and “Buy rollers”. You can build this skill in real time with a therapist or coach, developing a more tangible sense of what needs to happen – and in what order.

 

5. Motivation and dopamine: The missing drive

The problem: You don’t feel like doing the task – even when it matters.

What’s happening: Models of ADHD since the 1970s have focused on dopamine dysfunction as the cause of poor motivation. Newer views suggest ADHDers respond better to tasks with emotional or meaningful relevance for motivation and task engagement. The “generative purpose” model shows tasks are easier to start when emotionally resonant.

Result: Tasks that are boring or feel pointless lead to total disconnection. Purpose-based strategies can help to build momentum.

Therapy and coaching helps: Find your personal motivators – fascination, novelty, competition, challenge or urgency. These can all spark momentum and form an interest-based nervous system as outlined by psychiatrist William Dodson (see Dodson, 2022).

 

6. Emotional regulation: When feelings get in the way

The problem: Overwhelm, shame and/or anxiety freeze you in place.

What’s happening: Emotional regulation challenges are common in ADHD and can make it difficult to process “inputs” – such as tasks, feedback or even internal thoughts – calmly or proportionately. When unsure how to respond or act, an ADHDer’s “output” may become emotionally intense or reactive as a way to quickly discharge the emotional overload. This response can appear overly expressive or out of proportion to others, who may misinterpret it and miss the underlying distress.

Result: Tasks are avoided not because they’re hard, but because they feel emotionally unsafe. Fear of failure, shame or internalised criticism often play a central role.

Therapy and coaching helps: Talking through your emotional responses in coaching or therapy can hold great value – especially with someone who deeply understands ADHD. As you explore emotional regulation, you may also begin to make sense of other ADHD-related experiences, such as Rejection Sensitive Dysphoria (RSD) – an intense sensitivity to perceived rejection or criticism, even when it’s not intended. (Click here for Duncan’s blog about RSD)

 

ADHD procrastination at a glance

ADHD factor	How it fuels procrastination
Task initiation	“I don’t know where to start.”
Time blindness	“I thought I had more time.”
Distraction	“I got pulled into something else again.”
Planning and structure	“It’s too overwhelming or unclear.”
Motivation and dopamine	“I just don’t feel like doing this.”
Emotional regulation	“This feels too uncomfortable, so I’ll avoid it.”

 

Final thoughts

Like all human experiences, ADHD presents a wide range of ways in which people think, feel and respond to life’s demands and social systems. It’s not like having a broken leg – it doesn’t show up the same way for everyone. While there are shared patterns, ADHD expresses itself differently across individuals. Still, there’s value in discussing these challenges collectively, so we can better tailor support to the individual.

In ADHD, procrastination is rarely just a simple delay; it’s a signal of deeper, more complex issues both emotional and neurological. What looks like avoidance or laziness from the outside is often a reflection of real cognitive and emotional barriers on the inside (as well as the difficulty of managing how we take in and act on information).

With self-awareness, support and strategies tailored to the ADHD brain (e.g. coaching, therapy, medication and environmental adjustments), change is not just possible, it can be expected.

 

Further reading

Edmund Sonuga-Barke and Xavier Castellanos lay out the theory of default mode network (DMN) interference causing attention lapses in ADHD and other disorders. See Sonuga-Barke, E.J.S. & Castellanos, F.X. (2007). Spontaneous attentional fluctuations in impaired states and pathological conditions: A neurobiological hypothesis. Neuroscience & Biobehavioral Reviews, 31(7), 977–986.
Accessed 30 June 2025: https://www.sciencedirect.com/science/article/abs/pii/S014976340700022X?via%3Dihub

William Dodson, an ADHD coach and psychiatrist, is known for the “Interest-Based Nervous System” model of ADHD motivation and task engagement. See Dodson, W. (2022). How ADHD shapes your perceptions, emotions & motivation. Presentation. Accessed 30 June 2025:
https://adhd.dk/wp-content/uploads/sites/2/2022/05/Dodson-How-ADHD-Shapes-Your-Perceptions-Emotions-.pdf

 

Click the links if you’d like to visit Duncan’s therapy website or his directory entry on Attention Allies.

 

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Published 4 July 2025

 

All rights reserved © Copyright Duncan E. Stafford 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.

In her new poem “Procrastination”, Jackie Fernandez captures the chaotic inner monologue of an ADHD brain sidetracked by distractions, digital temptations and dopamine hits – offering a witty, all-too-relatable snapshot of modern-day avoidance.

 

I wake up in the morning

With the day full of things to do

My brain is swirling and listing

Like a bowl of vegan stew.

 

I lie back down in bed

Staring into space

Scratching my head

My brain thinking:

“It’s too nice in bed …”

“Stay a bit longer …”

“There’s no rush …”

I agree and my brain goes hush.

 

I do the worst thing ever

I pick up my phone to check the time

I can get away with 15 minutes more here

My brain pops poppers with the greatest cheer.

 

I check my emails

(That’s work, right?)

I check my texts …

I check my sleep log …

my heart rate …

my steps …

And I fall into the procrastination fog.

 

I check who won the Oscars

How Arsenal played last night

I Google serial killers from the true crime shows

“What are they doing now?”

“Are they still in prison?”

“Have they shown remorse?”

“Or are they a psychopath

a bully, a scumbag, a thug?”

“Do they still think they are tough

a big shot, still smug?”

 

I look at the things to buy on my Insta feed

My ADHD brain saying

“That is just what you need.”

I buy it with one click not thinking at all

wasting my money on something so small;

will I use it at all?

My shot of dopamine hitting my brain

Putting me on a temporary positive plain.

 

I then move on to play a game

Playing with puzzles

Making my moves

Moving up levels which is my main aim

I get frustrated when I run out of lives

I hesitate on the in-app purchases

“Do it!” brain says

I agreed not to spend money on this

“So what?”

I click and spend the money

Forgetting my partner does not find this expense funny.

 

I check the time

Hours have flown by

I jump out of bed

Trying to get to the list in my head

I feel really bad for not finishing the tasks that mattered

I should’ve never gotten out of bed

My procrastination in tatters.

 

Visit Jackie’s poetry website

 

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Published 30 June 2025

 

All rights reserved © Copyright Jackie Fernandez 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.

Many adults with ADHD grew up in a school system that misunderstood their struggles, leading to shame, masking and self-criticism. In this personal reflection, integrative counsellor and creative therapist Rich Hayden explores the lasting impact of the “just try harder” message.

(4 minute read)

In our modern society, we have the understanding that having ADHD affects attention (or lack of it!), impulsivity and hyperactivity; but this hasn’t always been in our social awareness.

If you’re over the age of 40 then you’ll probably remember neon socks and fingerless gloves, so let’s take a short trip back the 80s – my school years:

“If only Richard would try harder.”

“He’s an intelligent boy; if he just applied himself he would do so much better.”

“If he paid attention and concentrated, then he might learn something.”

“If he could just sit still and focus instead of fidgeting.”

These are all commonly repeated phrases from my old school reports; many of my clients and friends report having had similar experiences too.

This was the culture in the education system during the 1980s, 90s and even beyond. The system that missed all the obvious signs there were children with differently wired brains who required a different approach to learning. It has left behind a generation with many late-diagnosed ADHDers.

The thing is, many of us did try harder – those who didn’t rebel against the system and weren’t placed into the then-horrifically named “remedial classes” anyway.

We tried to meet the expectations that were required of us.

We tried to focus and concentrate.

We tried to achieve the grades.

We tried to make our brains pay attention to subjects we found boring.

We also beat ourselves up internally each and every time we failed.

In summary, we tried really damn hard to conform to being more neurotypical!

In other words, what we really learned was to mask more efficiently. One of the negative payoffs of this kind of masking is learning to switch off responses to things ADHDers would typically find fascinating or wonderful, like being lost in a hyperfocus thought tunnel about space and the universe during a geography lesson about capital cities!

What I find interesting about this is that, as I got older and my brain became more developed, I started to struggle with the masks and the loss of fascination in the things I desired. As a teenager it became almost impossible to concentrate on anything I wasn’t interested in. For me, at that time I began to be obsessed with music, particularly rock music.

I would hear songs in my head all the time and that was all I wanted to, or even could, concentrate on. Who the hell cares about capital cites of the world or what the formula for the area of the inside of a triangle is when you’ve got Slash’s epic lead break from “Sweet Child O’ Mine” going round on repeat? Literally note by note!

I still remember those horribly uncomfortable moments of having my hyperfocus broken and being pulled back into the reality of the classroom, only then to be scolded by the teacher for not paying attention. I remember the shame of those moments of criticism I received as a child.

I feel like that’s enough memory lane of the 80s and 90s, so back to the here and now. The all-too-real problem that this criticism of ADHD children creates is a lack of self-worth and confidence. This is often perpetuated and self-confirmed through experiences during teenage years and even into adulthood. It’s an issue I’ve seen a lot of ADHDers bring into the therapy room, whether they rebelled against the criticism as children or responded to it with masking.

The “just try harder” attitude really only ever results in a boat of criticism floating on an ocean of not being good enough that washes against islands of “I don’t know who I am and what’s wrong with me”. It also reinforces the message that many ADHDers have: that being different isn’t a good thing.

I work a lot using the concept of parts of ourselves with many of my neurodivergent clients. One part that is unsurprisingly common among ADHDers is a strong internal critic. The inward pointing finger. The voice that berates every single little mistake, failure, miss, non-achievement or wrong thing you do. The voice that says, “You’re not good enough”. The voice that says, “You should have tried harder”.

Of course, the reality is that none of these things are true. That critical voice is lying! The truth of the internal critic is that it’s just a huge distraction; it’s all hot air, smoke and mirrors. Like any other protector part, the critic is trying to keep us from feeling pain, often pain we’ve been unintentionally holding onto since childhood.

In my experience, the critic rarely works alone in these smoke-and-mirrors situations. I often see ADHDers also identify a perfectionist part who sets an unrealistic goal, a procrastinating part who wastes time and then, on the tail end, the critic who has a whale of a time berating you for the unachieved goal! This triad of parts can keep a distraction going for hours, even days in extreme situations.

The good news is that it’s possible to learn to manage yourself through this, to stop the harsh critical voice. It’s also possible to heal from the past and become more confident, self-assured and happy. It takes time and effort, but it’s all possible!

Having worked with the after effects of “just try harder” so much, I can’t help but ask myself what the outcome would be if an ADHD brain was supported to learn in its own unique way? Could it produce someone who is capable of deep, creative thinking and hyperfocusing, yet confident in their identity and secure in feeling good enough? Sounds like a person who has an awful lot to offer in my opinion!

 

Click the links if you’d like to visit Rich’s therapy website or hir directory entry on Attention Allies.

 

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Published 18 May 2025

 

All rights reserved © Copyright Rich Hayden 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.

A connection with an ADHD therapist transformed how transactional analysis-trained therapist Hayley Watkins understood neurodivergence and self-acceptance. Through therapy and a chaotic, joyful, city break, Hayley discovered the beauty in difference — and the power of celebrating it.

(4 minute read)

I had an interesting experience about a year ago.

Despite being a qualified counsellor, I like to get therapy as a client from time to time to enjoy some time to be my full self. My therapist at the time, Bridget,* was exactly what I needed. She had ADHD, and she played a big role in me learning to accept myself. At the time, I was still a bit unsure how much I accepted the possibility that I was autistic.

I think the term “self-acceptance” has an almost death-like quality to it. Acceptance is the fifth stage of the five stages of grief (Cruse, no date), so the word has a connection to death or loss, at least for me. That isn’t the spirit in which Bridget accepted herself: she did it with celebration and love – and her enthusiasm was infectious!

In fact, I should mention here that radical acceptance (Cuncic, 2024) is already a known term in the world of psychology and therapy, and that too has a certain grimness to it. That’s not what I’m going to talk about here, although I admit it’s in my nature to be upbeat.

Bridget loved the treasures that came with her ADHD. That doesn’t mean she ignored that it could be hard sometimes, and that an ADHD brain can make some things difficult that are easy for a neurotypical brain, but she loved the good parts, and she taught me to feel the same way about my neurodivergent brain.

While I score quite low for ADHD, I tend to have more ideas than I could ever make into reality, which is a characteristic of ADHD. One day, while telling Bridget about some ideas I’d had, she said she saw my ideas as “gems coming out of my head”. It was a lovely moment for her to point out that my neurodivergence gave me something to enjoy that I might have missed out on, if I’d been a “normie”.

Bridget had to retire in a hurry a few months later, but I’ll never forget the riches she saw in being neurodivergent.

Example: My city break

Months later, I arranged a city break with a friend called Jess.* Jess has an ADHD diagnosis, and it shows up in a number of ways, including a generous spray of her own gems. Jess had so many ideas for what we could do on our break that there was no way we could do all of them. She kept switching ideas for how to use the short time we had, to the point that by the time I showed up, I had no idea what we were doing any more.

I like to have a plan and know what I’m doing; it helps me feel secure. However, to stick to a plan we made ages ago would be pure drudgery for Jess. We were going to have to work around each other to get the best out of this trip.

Radical acceptance helped us both out. I accepted that I would feel untethered by the lack of a plan, and that instead, this trip would be a magical mystery tour – and it was! J’s huge cache of ideas meant we were never at a loss for what to do. Her spontaneity means that she’s great at thinking on the spot, remaking plans in double-quick time, and is one of the most resourceful human beings I’ve had the pleasure to meet. In short, she’s a great travel companion, and the best person for me to get lost in a strange city with!

It also helped that I accepted that I want structure but might not get very much of it during the trip. Mealtimes were enough structure for me, so I suggested we break for lunch after we finished enjoying the daffodils, sheer amount of space and seagulls in the park. I like the natural world, so I told Jess a little about the birds we had seen, which, as an American, she was unfamiliar with. Stopping for lunch gave us the chance to talk for an hour about sugar in the average diet in the States, inspired by one of the most chocolatey brownies either of us had ever had; she got to talk about something that mattered to her, and I learned something new about our cousins across the pond. Also, I got to sit in a corner in a wood-panelled cafe.

What was there not to like, for both of us, even if it was for different reasons?

There were a few other adjustments I needed that Jess could accommodate. She was staying longer than me, so I asked for dinner to be Thai (which I’m comfortable and familiar with, as is my autistic wont) instead of Indian (which I’m not, and isn’t), so she decided to have Indian the following night.

Jess and I are so different, and those differences could have made the visit difficult, but accepting one another and enjoying the surprises that we each present the other with made the trip a pleasure.

Note

* Not their real names.

References

Cruse. No date. Understanding the five stages of grief. Accessed 10 April 2025: www.cruse.org.uk/understanding-grief/effects-of-grief/five-stages-of-grief/

Cuncic, A. 2024. How to embrace radical acceptance. Accessed 10 April 2025: www.verywellmind.com/what-is-radical-acceptance-5120614

 

Click the links if you’d like to visit Hayley’s therapy website or her directory entry on Attention Allies.

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Published 4 May 2025

 

All rights reserved © Copyright Hayley Watkins 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.

Despite intelligence and creativity, many people with ADHD struggle to thrive in systems not built for their neurotype. In this article, Attention Allies counsellor Rebecca Burton suggests it’s time to rethink learning, productivity and support – starting with approaches that align with how ADHD brains actually work.

(4 minute read)

My father had an IQ of over 140 yet age 50 was dismissed from his job for forgetting to fill out paperwork. His family used to say, “What happened to him?”, faces drooping with sadness and a tone of regret. It’s such a familiar refrain for adults who have lived with undiagnosed ADHD that it’s almost a cliché, the school report that says “Could do better” and the accusations of laziness. It would be good to think this has got better, but I’ve recently heard of children with ADHD diagnoses described by teachers as “just lazy” and that “they can do it if they want to”.

I come across many people in my practice who live with a daily and constant sense of frustration, fully aware of their creativity, their highly tuned capacity to recognise patterns and use them to predict the future, their ability to make unusual and interesting connections at lightning speed, and also their fundamental inability to bring these talents into the world, not just because they lack executive function – though they do – but because the world does not yet routinely teach how to learn for the ADHD mind/brain.

It’s more or less commonly understood now that people with ADHD have low dopamine, a brain hormone that makes connections between neurons or nodules, in the brain. It’s what makes the brain “work”. Low levels of this hormone create a “slow brain”, which isn’t the same as saying “not very clever”; it’s more like saying that working memory and planning take more time than for someone in a high dopamine situation. So methods that take advantage of step-by-step approaches, or learning that begins with the basics or is simple and builds one step at a time, just aren’t easy for an ADHDer to access. When people (in general) are struggling, they are typically taught these kinds of methods. For example, if someone can’t draw a whole person at once, they might be encouraged to outline the basic shapes and build from there. The problem is that the ADHD mind/brain works better approaching something the other way around, with the finished product or the whole picture first, then extracting the needed information from that.

I remember at university shocking my tutors by not having a research question for a paper two weeks before the due date. I didn’t have a question but I did have an entire in-depth and fully annotated holographic research database in my mind. All I had to do was extract a single line of questioning and interrogate my database, and the essay would write itself. It did; I did well. But I didn’t have the language to explain that this is how my mind works. If I did, I would have saved all of us a lot of frustration and stress.

It seems that some ADHDers need to build a full picture of the topic they need information on, really milking their skills of creative thinking, experience-based intuition and ability to hyperfocus on things they are interested in, in order to do things that neurotypical people use their linear minds and executive function for. This is a different way of thinking, a different way of operating in the world. It applies to everything from a PhD thesis, to understanding a train timetable, to getting ready to leave the house. A large amount of context, hooking things to topics of interest (I make everything about visual aesthetics, for example, to get myself interested), and then working backwards, inwards from a bigger picture towards the detail that’s needed, rather than working forwards along a line where one thing leads logically to another.

Occasionally, this can take more time. However, I’m not sure that’s even an issue in and of itself; it’s more that we are not taught how to do this, so ADHD people are left fumbling along using the method inefficiently or fighting their natural tendencies, both of which take a lot of energy and create a lot of anxiety.

I think that if my dad had managed to get interested in note-taking, in using special stationery or in technological solutions, he might have saved himself from the humiliation of a sacking. But no one taught him how to do it.

The idea of creating workarounds that work for you is based on this kind of stuff. If you are often stressed by knowing you have all sorts inside you that you are unable to “get out”, if people are always underestimating you, if you are constantly berating yourself for being “lazy”, then it might be time to start thinking about what you need to work with your mind/brain rather than against it.

 

Click the link if you’d like to visit  Rebecca’s website or her directory entry on Attention Allies.

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Published 23 April 2025

 

All rights reserved © Copyright Rebecca Burton 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2025.

 

Menopause can be a particularly challenging time for those with ADHD. For some, it may even be the prompt that sparks a late diagnosis. But why? Here, psychotherapist and counsellor Lottie Storey explores how midlife hormonal changes affect ADHD and some other neurodivergences, and how therapy may help.

(7 minute read)

Over recent years, huge advances have been made in terms of awareness, understanding and treatment of neurodiversity. With this awareness has come an increase in people seeking a diagnosis for ADHD and autism. A 400% rise in adult ADHD referrals in the last four years takes the current UK total ADHD population to 2.6 million, while a recent paper in The Lancet (O’Nions, et al., 2023) estimates that there are potentially 750,000 (National Autistic Society, 2024a) autistic people in the UK.

Menopause, however, is an experience directly affecting 13 million people (NHS, 2022) in the UK right now. That’s a third of the population, from their twenties upwards, who are currently experiencing a wide range of physical and psychological menopausal symptoms that can last for years. And yet awareness is still lacking.

What is menopause?

Technically, menopause refers to one day only, the day that marks a year since periods stopped. Menopause happens at 51 years old in the UK, on average, with 45–55 being the generally accepted range. After menopause comes post-menopause, while the time leading up to menopause is termed perimenopause. What has only recently reached mainstream awareness is an understanding of quite how long and how hard this perimenopausal lead-up can be. We’re talking a decade or more.

The perimenopause can be a difficult enough time for neurotypicals. For menopausal people with neurodivergent conditions, it can be utterly life-changing.

Hormonal hell

Perimenopause begins with changes to hormone levels, specifically oestrogen, progesterone and testosterone.Oestrogen, in particular, plays a key role in regulating attention and emotions, sleep, memory and executive function, all areas that can be challenging for people with ADHD. Levels of oestrogen drop by about 65% during menopause, which has a knock-on effect on dopamine levels.

Dopamine is a neurotransmitter that affects mood, motivation and reward. Low dopamine levels can cause difficulty concentrating, lack of motivation and an inability to feel pleasure – again, these are areas that people with ADHD may already struggle with.

Oestrogen plays a critical role in regulating dopamine. As oestrogen and dopamine levels decline during perimenopause, those with ADHD may experience the following.

Worsened cognitive symptoms: Forgetfulness, difficulty concentrating and disorganisation can become more severe, affecting focus, planning and managing daily tasks.

Mental fog or “brain fog”: This can be more intense for people with ADHD, further impairing their ability to concentrate and remember things. It can also impact co-occurring conditions such as dyslexia.

Decreased emotional regulation: Mood swings, irritability, anxiety and depression are common during menopause, but may become more intense in those with ADHD.

Heightened anxiety and depression: The combination of hormonal shifts and ADHD-related emotional dysregulation can amplify anxiety and depression.

Increased insomnia: Lower oestrogen levels and night sweats can disrupt sleep patterns. People with ADHD may find it even harder to fall asleep or stay asleep.

Greater difficulty managing restlessness: ADHD symptoms such as restlessness or hyperactivity can make it difficult to wind down at night. This can worsen with menopause-related insomnia.

Fatigue: Tiredness exacerbates cognitive symptoms such as attention, forgetfulness and disorganisation. Managing ADHD becomes even more difficult when menopause-related fatigue sets in.

Lowered motivation: Reduced energy levels and motivation can lead to procrastination, which may already be an issue for those with ADHD. Managing day-to-day tasks can become more overwhelming.

In addition to the symptoms above, those with an AuDHD or an autistic neurotype might consider the suggestions from the National Autistic Society (2024b) that those with autism may also experience the following during menopause: intensified sensory sensitivities and overload; increased difficulty with social interaction and communication; difficulty with the lack of predictability around your bodily or sensory experience; difficulty identifying internal states, such as hunger and temperature (this is known as “atypicalinteroception”); and difficulty recognising and communicating emotions (known as “alexithymia”).

When the mask no longer works

Because of the intensity of the hormone changes and their impact on daily functioning, perimenopause strips many people of their usual coping strategies, making life much more difficult. When neurodivergent traits become more apparent, previously diagnosed people may seek extra help such as adjustments to ADHD medication or hormone replacement therapy (HRT).

For undiagnosed people, menopause can be a catalyst. They may realise that life has become much more challenging and that possible traits have come to the surface. Getting a diagnosis at this stage is helpful to better understand themselves in general as well as understanding why their experience of menopause is different to their neurotypical counterparts.

Managing menopause/neurodivergent intersections in the therapy room

As therapists, we often work with clients who have difficulties regulating their mood and emotions, their communication and/or relationships with others. We may also be used to working with neurodivergent clients. It’s essential that practitioners become just as familiar with the symptoms of menopause because of the ways in which they can affect clients’ lives more generally, as well as the possibility of previously masked neurodivergence becoming un-maskable.

Medical misogyny is already an issue for women and menstruating people. Often, patients presenting with low mood as a result of menopause may be offered treatment for depression or anxiety. The likelihood of misdiagnosis of perimenopause and consequent lack of appropriate treatments being offered is very real, with anecdotal evidence suggesting finding an informed GP can be hit-and-miss. Likewise, those seeking diagnosis for a neurodivergent condition may struggle to get the help they need because their menopausal symptoms worsen their cognitive function, making it even more difficult to advocate for themselves.

By informing ourselves, as therapists, we can avoid perpetuating further harm. Instead, we must do our own work, being mindful of the many ways in which menopause may impact identity. Staying curious to the experiences of our clients is critical, applying different – even multiple – lenses through which to understand their lives. We can facilitate self-reflection, self-compassion, self-awareness and validation. We can support clients to develop new strategies to make adjustments at home or at work in order to manage their lives more effectively. Think laterally – could you offer sensory-friendly spaces for autistic clients? Or tailor your mindfulness exercises to work for clients with ADHD? Could you advocate for better awareness within our profession?

The therapy room should always be a place of safety for clients. For our neurodivergent, menopausal clients, we must offer an indestructible shelter from this particularly turbulent storm.

 

References

National Autistic Society. 2024a. Accessed 17 February 2025: www.autism.org.uk/advice-and-guidance/professional-practice/under-diagnosis-of-autism-in-england-a-population#:~:text=Through%20examining%20the%20data%2C%20the,as%20the%20government%20typically%20quote

National Autistic Society. 2024b. Accessed 17 February 2025: www.autism.org.uk/advice-and-guidance/topics/physical-health/menopause

NHS. 2022. Accessed 17 February 2025: www.engage.england.nhs.uk/safety-and-innovation/menopause-in-the-workplace/#:~:text=It%20is%20estimated%20that%20there,can%20last%20for%20several%20years

The Lancet (O’Nions, et al.). 2023. Accessed 17 February 2025: www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00045-5/fulltext

 

Click the links if you’d like to visit Lottie’s therapy website  Lottie’s mental health copywriter site or her directory entry on Attention Allies.

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Published 23 February 2025

 

All rights reserved © Copyright Lottie Storey 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

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With professional and personal interests in the subject matter, counsellor and therapeutic coach Sarah Guthrie takes a look at some of the potential interconnections between the highly sensitive person (HSP) and attention deficit hyperactivity disorder (ADHD) with a side order of rejection sensitive dysphoria (RSD) thrown in for good measure.

(5 minute read)

Have you ever experienced the feeling of having been plucked from obscurity and dropped into unfamiliar territory? Thirty-eight years on Earth have taught me that humans can feel like aliens, lone wolves walking among humans. Sometimes, life can feel like a Lord of the Rings trilogy – fighting fires and being unable to clear the cobwebs from your mind.

My ADHD diagnosis was an early one, as was my dyspraxia. I would often experience sensory overload. Sometimes, a small town in Sussex, UK, could feel like the hustle and bustle of London’s Piccadilly Circus. When I was a small child, I would check on my cuddly toys to make sure they were comfortable to curb my anxious feelings. This included ensuring they were facing up before bed every night. Fireworks, thunderstorms and banging doors – any loud noise – would scare me. I would walk around with my fingers in my ears, trying to block out the sounds.

I lived in London for most of my 20s, leaving in my early 30s. Stress formed a part of my life: fast-paced jobs; busy, noisy house shares; and long commutes to see friends on crammed tubes.

Understanding overwhelm

While I was training as a counsellor in my early 30s a conversation with my therapist led to a deeper understanding of my overwhelm. My therapist asked me if I had heard of the term “highly sensitive person” (HSP). I took a deep dive into all things HSP, reading The Highly Sensitive Person: How to Survive and Thrive When the World Overwhelms You by psychologist Dr Elaine N. Aron (originally published in 1996).

While useful in therapy for understanding sensitivity and managing overwhelm, HSP isn’t universally accepted or included in diagnostic frameworks. However, many therapists, especially those working with neurodiversity, use the HSP personality trait as a framework to validate experiences, improve emotional regulation and enhance well-being. By factoring in HSP to working methods with clients, we can see overlaps between HSP, RSD, ADHD, empaths and autism (ASD).

Highly sensitive people can be emotional sponges, especially if they are also empaths. While empaths share the traits of HSPs, they often feel other people’s emotions more deeply, sometimes experiencing those feelings as their own. HSPs can also be high sensation seekers who are easily bored and need variations in their routine.

I see countless clients, many of whom can relate to aspects of ADHD but for whom a diagnosis wouldn’t fit. This includes struggles with chronic stress, anxiety, low self-esteem, as well as procrastination, boredom, a desire to daydream and a fear of failure that brings with it people-pleasing tendencies. Being an HSP has many benefits. HSPs are seen as thoughtful, creative, conscientious, empathetic and intuitive, and often look at the bigger picture. For some of these clients, the concept of HSP can be a valuable framework to increase their understanding of their experience.

You may have read a recent blog post on this site  (“Can autonomy, competence and relatedness be the ADHDers’ defence against RSD?”) about rejection sensitive dysphoria. RSD is an intense fear of rejection and failure. It can be debilitating for those who have it. Many of the highly sensitive clients (with and without ADHD) whom I have seen resonate with the symptoms of RSD. However, while there is no research explicitly linking RSD and HSPs, there have been studies linking emotional sensitivity, social anxiety and experiences of rejection. Psychologist and therapist Dr Ari Tuckman, who has written extensively about ADHD, including RSD, notes that people with ADHD who experience emotional dysregulation may often experience RSD-like symptoms. Moreover, a key component of Aron’s work is heightened emotional reactivity, a trait common in RSD. In other words, highly sensitive individuals might be more emotionally reactive, causing deeper emotional responses and leading to a perceived fear of rejection and criticism. In short, HSPs and those with RSD exhibit a heightened sensitivity to emotional and social situations. Additionlly, having RSD as well as being an HSP amplifies emotional distress, and a person with both may need more time to decompress and prioritise self-care in order to prevent burnout.

This information from my therapist gave me a new understanding of myself. Through therapy, I have learned to strengthen my mind–body connection, sit with my anxiety and calm my nervous system in ways I hadn’t before. This gave me the power to take control of thoughts and feelings – noticing what was my anxiety and what was someone else’s. Slowing down the mind and focusing on the body through mindfulness, movement, breathing, tapping and visualisations helps to manage overwhelm.

Next time someone says you are too sensitive or too weak, remember this: your personality is your strength. Society requires many personalities to thrive, and your sensitivity might be the key to your success.

Further information

For more information on Dr Ari Tuckman and the books he has written, visit https://tuckmanpsych.com/

For more information on Dr Elaine N. Aron and her work, visit: https://hsperson.com/

To complete the HSP questionnaire visit: https://hsperson.com/test/highly-sensitive-test/

To complete the HSS questionnaire visit: https://hsperson.com/test/high-sensation-seeking-test/

 

Reference

Aron, Elaine N. 1996. The Highly Sensitive Person: How to Survive and Thrive When the World Overwhelms You.

Click the links if you’d like to visit Sarah’s therapy website or her directory entry on Attention Allies.

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Published 6 January 2025

 

All rights reserved © Copyright Sarah Guthrie 2025. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

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Attention Allies founder and specialist couples therapist Duncan E. Stafford offers some introductory insight to how SDT can be a strong, flexible and empowering framework to help support those living in mixed ADHD/neurotypical relationships.

(5 minute read)

Couples therapy involving one partner who has an ADHD neurotype requires a compassionate and structured approach to foster success. Traditional therapy models often unintentionally frame the work as an ADHD partner needing to be “fixed” or that they must be taught or learn “how to conform” to a neurotypical concept of relationships. This framing tends to alienate ADHDers and can exacerbate relational tensions rather than help to address them.

Many couples who seek help at my practice report that previous therapists had struggled to balance the needs of both partners, often overlooking or underestimating the distinct challenges and strengths associated with ADHD. Without proper recognition of these issues, therapy risks becoming another source of frustration for the mixed-neurotype couple, leaving them feeling unseen and unsupported.

From my 25 years of professional experience and 37 years in a successful, loving mixed-neurotype marriage, I’ve found that the core principles of Self-Determination Theory (SDT) – autonomy, competence and relatedness – provide a robust framework for fostering resilience, empathy and growth in couples therapy. These principles allow partners to navigate conflicts constructively and create a supportive, thriving relationship.

For individuals with ADHD, the often-reported challenges such as disorganisation, impulsivity and difficulties with emotional regulation can strain communication and mutual understanding in romantic relationships. If not addressed, these issues may lead to misaligned expectations, frustration and feelings of disconnect.

Introducing the SDT framework for couples work

SDT was developed by psychologists Edward Deci and Richard Ryan and was first comprehensively outlined in their 1985 book Intrinsic Motivation and Self-Determination in Human Behavior. Focused on understanding the factors that enhance or undermine motivation, SDT identifies three essential psychological needs:

Autonomy – the need to feel self-directed and in control of your own actions

Competence – the need to feel effective and capable

Relatedness – the need to feel connected, valued and have a sense of belonging.

An SDT-based approach to couples work will help both partners identify and meet their psychological needs while simultaneously promoting mutual respect and empathy within the couple. By empowering an ADHD partner to develop tailored strategies for managing their challenges, therapy can increase autonomy. The building of confidence through therapeutic work helps to develop abilities (competence), and enhancing emotional connection and understanding in couples work increases relatedness.

Therapy can transform recurring conflicts into opportunities for deeper connection and shared growth. This approach acknowledges the ADHD dynamics in the relationship – creating a pathway to sustainable harmony and partnership.

Beginning to apply SDT in ADHD/NT couples work

ADHDers often experience unique challenges in romantic relationships, and the common issues ADHD can bring often strain the communication systems and understanding of a couple. Using SDT in couples work provides a structured framework for addressing the issues and challenges that are especially prevalent in mixed-neurotype relationships.

When I first met Jess (diagnosed with ADHD) and Mo (neurotypical), their relationship was mired in daily conflict and palpable frustration. Sessions often began with a seemingly minor disagreement that quickly escalated. On one occasion, Mo was deeply frustrated because Jess had once again missed a deadline for paying a household bill. Despite repeated “requests” to “do it right next time,” Mo felt nothing ever changed, leaving her to shoulder most of the family responsibilities.

What I observed was a deeper pattern: Mo’s attempts to manage Jess’s behaviour were experienced by Jess as micromanagement, which undermined her competence (confidence in her ability to handle responsibilities) and autonomy (freedom to self-direct). For Jess, this dynamic triggered overwhelm and defensiveness.

The core issue lay in miscommunication of their individual needs and understanding of the other. As a neurotypical individual, Mo prioritised structure and predictability. Meanwhile, Jess’s ADHD presented challenges with timing and task prioritisation. These differing approaches turned relatively small issues into significant conflicts.

SDT strategies in action for Mo and Jess

Autonomy: Jess was encouraged to handle tasks in a way that worked for her. Mo’s request was for Jess to simply set up an automated payment, but this triggered Jess’s childhood memories of being seen as incompetent. Instead, Jess set about designing a visual task board that included a wider set of financial goals and accounts. With the use of colour and an impressively artistic hand-drawn financial flow chart, Jess successfully navigated the challenge and was able to stick to, and increase, her financial responsibilities for the family.

Competence: Therapy focused on building Jess’s skills without criticism, which helped her to feel more effective in managing responsibilities. Mo’s competence increased once she realised it wasn’t her responsibility to do things it had been mutually agreed Jess would do. Mo took pride in her new skill of “sitting back”.

Relatedness: Mo learned to express concerns empathetically, removing frustrated responses and replacing them with expressive dialogue like “I feel anxious when bills are late”. Jess was encouraged to share how constant reminders and micromanagement felt overwhelming, fostering mutual understanding.

By applying SDT models, the conflict between Jess and Mo began to reduce. This allowed them to build further trust in one another, transforming challenges into opportunities for growth.

This article provides an introduction to how SDT can begin to reshape ingrained patterns in mixed ADHD/NT relationships. Visit us again for future articles on applying SDT in therapy.

You might also like to view Can autonomy, competence and relatedness be the adhders’ defence against Rejection Sensitive Dysphoria where you can read more about basic SDT in connection with ADHD.

Note: Jess and Mo are composite characters, inspired by a mix of consensually shared and fictionalised examples.

 

References

Deci, Edward L. and Richard M. Ryan. 1985. Intrinsic Motivation and Self-Determination in Human Behavior.

 

Click the links if you’d like to visit Duncan’s couples therapy website or his directory entry on Attention Allies.

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Published 8 December 2024

 

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

Psychotherapeutic counsellor Bev Woolmer helps us to understand that ADHD doesn’t just happen in a vacuum. An ADHDer’s comorbid conditions can impact and/or mask symptoms of the condition.

(5 minute read)

Awareness, information and debate about ADHD have increased significantly. ADHD has become part of our social discourse and the increase of people seeking diagnosis and support is rising. It is likely that within our circles we know people with ADHD or we may be neurodiverse ourselves.

Data from the NHS Business Services Authority show that in 2022–2023, more adults were prescribed medication for ADHD than children – a rise of 32% in adult prescriptions (NHSBSA, 2023). In March 2024, the National Institute for Health and Care Excellence (NICE) estimated that 3 to 4% (roughly 1.9 million adults) and 708,000 children in the UK have a diagnosis of ADHD.

Statistics aren’t, generally speaking, my thing, but what resonates here for me, and something that is maybe less discussed, is ADHD and comorbidity (AADD UK; Plos One; The Understood Team). Comorbidity means the tendency for one condition to co-exist with another. What I recognise both personally and professionally is how anxiety and depression are often diagnosed, and what can often be missed are conditions within the umbrella of neurodiversity.

Recognising in later life that my brain is neuro-spicy, that there is a reason why numbers, “clumsiness”, not knowing my left or right, being a “daydreamer” (a firm favourite in school reports) all started to fall into place. I began to piece together the things that had challenged me and began to see all this was unique.

It is no surprise this is also a large feature within my work as a counsellor with clients. The privilege in holding space for others, where the mask they’ve worn can be explored with compassion and curiosity. A supportive ally on the journey of self-discovery, the reflecting back, seeing the signs and missed opportunities, often a grieving process, recognising the loss and the re-building.

This piecing together often brings into view co-morbidity and how the presence of these can affect ADHD symptoms as well as mask ADHD.

How anxiety and depression mask ADHD

Anxiety: this can impact the ability to concentrate, the racing of thoughts, constant worry and fear. It can exist as a generalised anxiety disorder and be experienced in relation to health or social anxiety. Perfectionism, and comparing oneself to others who seem to function and manage, are often internalised. About 50% of adults with ADHD will also have an anxiety disorder.

Depression: adults with ADHD are three times more likely to experience depression; they are more likely to be significantly affected by their symptoms than those with either disorder alone. Low mood and low self-esteem can impact self-image and can result in a sense of failure in not meeting expectations or goals. This can impact both personal and professional relationships, struggles with communication, reading body language and “fitting in”.

 

How specific learning differences mask ADHD

Specific learning differences are neurological conditions that can impact how a person learns. These are not related to intelligence, and those with one or more of these conditions are more likely to have ADHD or ASD than people who do not have a specific learning difference.

Dysgraphia: this can cause challenges with written expression, handwriting, spelling, grammar and putting thoughts onto paper as well as fine motor skills – for example, holding a pen.

Dyspraxia: challenges with movement and co-ordination, including poor hand-to-eye co-ordination, manual dexterity and poor balance. It can also affect language, perception and organising thoughts.

Dyscalculia: affects the ability to acquire arithmetic skills – for example, in performing mathematical calculations, understanding place value, reading timetables, telling and tracking of time, and challenges with distinguishing left and right.

Dyslexia: causes difficulties with reading, writing and spelling. It can cause confusion over the order of letters, which may be written the wrong way round. It can also cause challenges with following directions, perception, planning and organisation.

Empowering ourselves

Being able to understand ourselves, to name what challenges us, can enable and empower us. It can provide an opportunity to learn strategies, to reframe our story and to find a sense of self of who we are. As poet Maya Angelou says: “If you’re always trying to be normal, you will never know how amazing you can be.”

 

References

AADD UK. No date. Accessed 3 December 2024: https://aadduk.org/symptoms-diagnosis-treatment/comorbidities/

National Institute for Health and Care Excellence. 2024. Accessed 3 December 2024: https://cks.nice.org.uk/topics/attention-deficit-hyperactivity-disorder/background-information/prevalence/

NHS Business Services Authority. 2023. Accessed 3 December 2024: https://media.nhsbsa.nhs.uk/news/nhs-releases-mental-health-medicines-statistics-for-20222023-in-england

Plos One. No date. Accessed 3 December 2024. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277175

The Understood Team. No date. Accessed 3 December 2024:https://www.understood.org/en/articles/adhd-comorbidity

 

In “ADHD, ME …”, sister poem of “ADHD? ME?”, poet Jackie Fernandez illuminates the work struggles she endured around her initial diagnosis just before the Covid-19 pandemic. Full of Jackie’s usual wit and charm, “ADHD, ME …” continues to allow readers into the thoughts and journey of one woman with a late diagnosis of ADHD.

 

I was diagnosed as we were going into lockdown

Covid taking over our lives

Boris acting like a clown

As we got used to living day and night in our dressing gowns.

 

It was only a week or so from getting this bombshell

I was assessed by a psychiatrist

Asking me loads of questions

About my childhood

About school

About the jobs I had and lost

With little notice

But at a great cost

To my confidence

Unsure of my skills

My experience

Was I any good at it?

Did I try my best?

Why couldn’t I fit in?

RSD wanting to put me in the bin

 

I worked for a charity

That supported people with disabilities

Providing stability

To folk who struggled with mobility

Or folk who were neurodivergent

Some very observant

Some obsessed with detergent

Some talking like a machine gun

Because in their head it was urgent.

 

I thought I was in the right place

To share my diagnosis with grace

And not hide my face.

 

I told my manager

I have ADHD

Could you share this with the board

It will shed light on how I work

And understand how ADHD can be a positive quirk

 

I didn’t get the response I expected

Words that would’ve been a warm embrace

But  in reality,

I’ve never felt so rejected.

 

She explained how now was not the right time

We had to focus on Covid-19

I had to look after my staff team

Steady the boat

Keep it afloat

 

A Secret

Like it was something so bad

So awful

So earth-shattering for them

 

I felt unimportant

But took it on the chin

I had to focus on my job

Put my feelings in the bin

 

The news was shared eventually

To all the board members

Who’d known me for years

But things did not look like they appeared

 

An email was sent out to all

Telling them of my ADHD

I was expecting to be bombarded with responses

Telling me its ok

We will support you

How have you managed for so long?

We are right behind you

You’ve done nothing wrong.

 

I was bombarded by silence

It   was    deafening

Soundless

So, so quiet

So, so still

Nobody said anything to me

It gave me quite a chill.

 

I had no support

They didn’t want a CEO to have ADHD

What an embarrassment I was to them

To have a disability

To not be neurotypical

“Normal”

A role model

To not be abnormal

 

I felt I let them down

I had taken a step down

I had lost my crown

 

Visit Jackie’s poetry site

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Published 6 December 2024

 

All rights reserved © Copyright Jackie Fernandez 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

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