“Stress always makes my ADHD symptoms worse and to top it off, when my ADHD isn’t under control, that creates more stress,” a member of a popular online ADHD forum shared not too long ago. Several other members chimed in with their similar experiences.

“My symptoms are really made worse by stress,” another writer said. A third member contributed, “Sometimes stress makes my symptoms worse, I think it depends on how stressed I am and whether it feels really out of control or not.”

Does feeling stressed out really make your ADHD symptoms worse? Or could it be that the daily disarray caused by ADHD symptoms just makes you feel more stressed?

CHADD Professional Advisor Board member Desiree W. Murray, PhD, is a senior research scientist and the associate director of research for the Frank Porter Graham Child Development Institute at the University of North Carolina. She says we need to think about the question in terms of the relationship between ADHD and stress.

“That relationship is complex,” she says. “There is most likely a bidirectional, multidirectional, relationship between ADHD and stress.”

In other words, difficulties caused by ADHD symptoms can cause you to feel stressed, and stress can make those symptoms worse. Our forum members’ experiences are supported by research.

“When someone says that ‘stress is making my symptoms worse,’ I think there is a fairly strong body of literature with examples of that happening,” Dr. Murray says. “I have also heard lots of stories about how the symptoms of ADHD can create stress and I think that is true, too.”

Researchers are interested in the links between ADHD symptoms and stress. A majority of adults report feeling stressed over various situations in their lives, with 73 percent of people experiencing psychological symptoms and 77 percent of people reporting physical symptoms of stress, according to the American Institute of Stress.

Writing in the Journal of Attention Disorders, researchers note that ADHD symptoms are associated with stress, especially for those adults who primarily have the inattentive presentation. Chronic stress makes symptoms worse, and even causes chemical and architectural changes to the brain, affecting the brain’s ability to function. In Nature Neuroscience, researchers note that stress affects the prefrontal cortex, the same location of the brain affected by ADHD. There, stress reduces neuronal firing and impairs cognitive abilities.

Dr. Murray says that research has shown repeatedly that stress causes changes to the brain. There is a decrease in the executive functioning abilities of the brain, often seen in the person’s ability to organize information and activities, and to manage emotions.

“What we can see over time, especially when stress is at the level we could consider toxic or chronic—or traumatic—you can see some effects on the brain,” she says. “It’s both brain structure, and size of some specific sections, along with brain function, as related to some of the brain chemicals. There is a reduced cognitive capacity for making decisions, goal-setting and problem-solving—the things we think of as related to cognitive self-regulation.”

In addition to these challenges, Dr. Murray says the combined stress and ADHD symptoms can harm adults’ personal relationships, causing friendships to sour and marriages and partnerships to enter turbulent waters. Too often, the person finds herself with a shorter fuse and blurting out things that are better left unsaid, she says.

“Those relationships get impaired by those things, and then it’s stressful,” she says. “The person then experiences negative feedback and rejection. That’s kind of a vicious cycle.”

Not all stressful situations are created equally, though. A short-term stress-causing event can have some benefits, Dr. Murray says.

“There are times and situations when stress is very motivating,” she says. That might be studying for an exam or finishing a project for work on a deadline. This type of stress can help with productivity because it causes you to “hunker down and focus,” she says.

“Some amount of stress up to some level can serve some purposes,” Dr. Murray says. But thriving on stress and using it as a tool to accomplish your goals too often can back-fire and then “you hit a point when it’s interfering with your abilities.”

So, what can you do to manage stress better and lessen its impact on your ADHD symptoms?

Dr. Murray says it’s important to address both the cognitive challenges and the emotional challenges. Techniques such as mindfulness and deep breathing can help to quell stress when it arises. Creating and maintaining routines and systems can also help to minimize stress in your environment by limiting decisions that need to be made and helping to automate daily life.

Once in a calmer position, looking at the situation with a critical eye can help to find ways of improving or changing the situation. Dr. Murray suggests asking yourself if there are ways to change the situation, or if the cause of the problem is because the situation reflects a poor match between what is required and your skills, especially in employment.

“For adults with ADHD, one of the things, I think, is about the matching of one’s strength and skills to their work and job situation,” she says.

Other techniques include incorporating more exercising into your routine and developing personal hobbies. For many parents, working with your spouse or co-parent to allow you more time on your own to unwind can also help reduce stress levels.

If stress continues or you find it is affecting your symptoms even further, discussing the situation with your doctor may also be helpful. Changes in your treatment plan, lifestyle, or working with additional health professionals can be helpful in managing stress.