You might feel you’re having trouble paying attention or controlling your emotions, forgetting things, and not being organized – and be unsure if you have ADHD or it’s just stress. Many grownups end up in a baffling overlap in between the two. The reality is, chronic stress is not only like ADHD. It can be a positive trigger, and in a few instances can produce symptoms so close that even the most experienced practitioners hesitate to make the diagnosis.
We explain the science of ADHD and chronic stress, how these two disorders are related in a vicious cycle, and address some of the most commonly asked questions adults are having around this nuisance.
What Is ADHD in Adults, Really?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with brain structure and chemistry abnormalities, specifically the regulation of dopamine and norepinephrine in the prefrontal cortex. This area controls executive functioning which refers to planning, self-control of impulses, focusing attention, and regulating emotion.
Adults with ADHD may not be the same as the hyperactive child who constantly bounces off the classroom walls. It is likely to appear as:
- Persistent lack of organization and on-time work completion
- Racing mind or fleeting mental thoughts
- Impulsivity, irritability, frustration or overwhelm
- Lacks of concentration in routine or dull work
- Impulsive choices in relationships, money or employment.
- Desperate awareness of low achievement in relation to one’s high intelligence
The mechanisms behind these symptoms are neurobiological and occur in most circumstances in a person’s life but they do not happen at the same time or to the same degree.
What Chronic Stress Does to Your Brain
But now things get complicated. Chronic stress (a busy career, challenging relationships, financial worries, taking on parenting responsibilities or experiencing compounded trauma) keeps the brain constantly on edge. When it’s stressed, the cortisol hormone floods the system, and after some time, it starts to take its toll on the same brain region targeted by the ADHD brain.
Chronic stress:
- Fine-tunes the brain’s prefrontal cortex, which diminishes your ability to focus, plan, and control your impulses
- Affects the dopamine pathways, making it harder to feel motivated or the sensation of reward
- Activates the amygdala, the brain’s alarm system, which creates emotional reactivity and anxiety
- Disturbs working memory, which is the ability to keep things in mind and then take action with them
Sound familiar? It should – those are the symptoms of ADHD. Chronic stress after months or years produces a very similar functional response in the brain to what is observed by neuroimaging in untreated ADHD.
The Mimicry Problem: Stress-Induced “ADHD Symptoms”
Perhaps one of the most important – and least recognized – facts is that chronic stress can trigger a full range of ADHD symptoms in individuals who do not suffer from ADHD at baseline. This is known as stress-induced cognitive dysfunction and includes:
- Difficulty focusing and/or problems holding attention
- Memory impairment, miscellaneous
- Unable to tackle small activities
- Procrastination and avoidance
- Poor time management
- Emotional volatility
Context and history is the critical difference. Actual symptoms of ADHD are confirmed in all settings and can be traced back to childhood (even if no diagnosis was given in childhood). Symptoms of stress reactivity are more likely to be during periods of high stress and better when that stress is gone or controlled.
That is why, before a diagnosis of ADHD can be made in adults, a complete clinical assessment, including a detailed developmental history, is crucial.
When You Have Both: The Vicious Cycle
Chronic stress is more than a mimic – it is fuel on an already burning fire for adults who do suffer from ADHD.
ADHD already affects the brain’s ability to control cortisol responses. Individuals with ADHD may feel more strongly emotional responses to stressors, find it harder to calm down after a stressful event, and are more likely to feel overwhelmed. In essence, their brains are hot under pressure.
Throw in a hostile environment, financial insecurity, problems with the spouse, and the brain takes a hit again. Executive functioning skills continue to decline. Emotional dysregulation intensifies. Sleep is already typically impaired in children with ADHD; it is exacerbated. And sleep deprivation? That’s enough to mimic and exacerbate ADHD symptoms.
The result is a self-reinforcing loop:
ADHD symptoms → life disorganization → chronic stress → worsened ADHD symptoms → more life disorganization → more stress
If the cycle is not interrupted at various stages, it is almost impossible for any action to take root.
What This Means for Treatment
For adults experiencing the overlap, comprehending how ADHD and chronic stress interact is of critical importance when deciding on the best treatment approach.
For those with true ADHD and chronic stress: Use treatment for both. Stimulant or non-stimulant medications can normalize brain baseline function, but combined with lack of stress reduction strategies (therapy, restructuring, somatic practices, sleep hygiene) the benefits of medication are limited.
For those with stress-induced symptoms (no ADHD): You might find stimulation to feel like you are being diagnosed with ADHD when really, you are not. You can feel stimulated for a little while without doing anything to cure the underlying problem. Chronic stress should be the primary treatment, through evidence-based treatments including Cognitive Behavioral Therapy (CBT), Mindfulness Based Stress Reduction (MBSR) and lifestyle treatments.
For everyone: The prefrontal cortex can heal. The good news is that long-term stress can have a significant effect on cognitive functions, but with proper stress management, sleep, exercise, and therapeutic support these functions can be restored.
Frequently Asked Questions
Q: Can chronic stress cause ADHD in adults who never had it as children?
No, technically, ADHD is a neurodevelopment disorder with its origins in early brain development. But chronic stress can bring about symptoms in adults that are practically the same as those of ADHD. This is also referred to as pseudo-ADHD or stress-induced attentional dysfunction. Although the mechanism is different from actual ADHD, it is very real and very debilitating. When major stressors are fixed, and the symptoms improve significantly, it’s a helpful diagnostic clue.
Q: How do I know if I have ADHD, chronic stress symptoms, or both?
It’s really hard to guess without a thorough clinical assessment. Useful questions to ask yourself: Had poor focus, organization or impulsiveness during childhood (even if mild)? If yes, do your symptoms present in most aspects of your life, at all levels of stress? Did they first start or have suddenly increased in severity during a certain stressful period? Prior to any ADHD diagnoses, a full developmental history and symptom checklist should be done by a licensed psychologist or psychiatrist with an adult ADHD specialty, and assessment of other factors should take place.
Q: Does ADHD make you more vulnerable to chronic stress?
Yes, significantly. People with ADHD frequently suffer from ‘emotional dysregulation’: a shorter fuse for frustration, quicker upswing in emotional arousal and a longer time to downswing after stressful events. In ADHD the brain’s prefrontal cortex does not have the capacity to calm down the activity in the amygdala. This results in greater and longer effects of everyday stresses. With the continued rise in reactivity, there can be chronic states of stress without any significant life situations.
Q: Can treating my stress improve my ADHD symptoms?
Yes – and one of the most empowering for adults who have ADHD. Stress-reduction techniques, such as consistent or sustained aerobic exercise, good sleep, relaxation routines, and psychotherapy, have all been found to support the function of the executive system and attention to tasks without the use of ADHD medication. In general, increasing availability of these two neurotransmitters, dopamine and norepinephrine, in the prefrontal cortex region of the brain has been well-documented in exercise, mimicking some of the effects of stimulant drugs. Stress reduction will not cure people who need medication, but it can certainly enhance the effects.
Q: My ADHD medication stopped working as well as it used to. Could stress be the reason?
It is a very common and overlooked occurrence. Chronic stress can raise cortisol levels, which, in turn, can alter the sensitivity of dopamine receptors, thereby reducing the effectiveness of stimulant drugs, such as the methylphenidate or amphetamine salts. Don’t assume that an increase in the dose is necessary when your drug seems to be ineffective during stressful times when it was previously effective. Speak with your prescribing doctor about your stress levels and see if your meds work better for you if you choose to work on managing stress.
Q: Is there a specific type of therapy that helps both ADHD and chronic stress?
This is something that can be treated by a number of therapies. This type of therapy, called cognitive behavioral therapy for ADHD (CBT-A), addresses the thought patterns, avoidance behaviors and organization difficulties involved with ADHD, and develops stress resilience skills. Both populations have shown positive outcomes with Mindfulness Based Cognitive Therapy (MBCT) for attention regulation and emotional reactivity. Chronic stress due to trauma may be a more common comorbidity of ADHD than is generally acknowledged and is where somatic therapies and EMDR can be of particular value.