April is National Stress Awareness Month—though the majority of individuals and families affected by ADHD are likely to tell you that every month can be stress awareness month.
Stress—a state of worry or mental tension caused by a difficult situation—is something that we all experience, but we don’t all experience it in the same way or for the same reasons. For someone with ADHD, stress can be a constant companion, and that feeling of unending stress makes ADHD symptoms worse. It seems as if ADHD symptoms cause stress and then the stress increases ADHD symptoms.
Chronic stress causes chemical and structural changes to the brain, affecting its ability to function. The part of the brain most affected is the prefrontal cortex—the same part of the brain that is impaired by ADHD.
CHADD’s resources on ADHD and stress offer ideas and guidance for finding ways to reduce your own stress or the stress within your family.
Stress and ADHD
“Stress always makes my ADHD symptoms worse, and to top it off, when my ADHD isn’t under control, that creates more stress,” wrote one member on a popular online ADHD forum. Several other members chimed in with their similar experiences.
“My symptoms are really made worse by stress,” shared another writer. A third 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.”
Desiree Weems Murray, PhD, a former member of CHADD’s professional advisory board, leads the UPSIDE Team at the University of North Carolina. Her research examines how stress contributes to emotional dysregulation. 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. Research supports the lived experiences expressed by members of our online forum.
“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,” says Dr. Murray. “I have also heard lots of stories about how the symptoms of ADHD can create stress, and I think that is true, too.”
Research into stress and ADHD symptoms
Dr. Murray adds that research has shown repeatedly that stress cause 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.”
Dr. Murray says the combined stress and ADHD symptoms can harm an adult’s 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.
“Those relationships get impaired by those things, and then it’s stressful,” she adds. “The person then experiences negative feedback and rejection. That’s kind of a vicious cycle.”
Stress can be harmful
In addition to the increased challenges to executive function, chronic stress can take a toll on the rest of the body.
Allison Chase, PhD, is the regional clinical director at Pathlight Mood & Anxiety Center in Austin, Texas. She says stress has a considerable effect on physical health in addition to mental health.
“I think that the greatest concern about chronic stress is the impact it has, physiologically, on the body,” says Dr. Chase. “It can be it can be very concerning, as it creates great problems for all of our internal working systems.”
Health challenges can include heart disease, poor management of chronic conditions such as diabetes, and can also contribute to depression, anxiety, disordered eating, and obesity.
Poorly managed ADHD, especially when further aggravated by chronic stress, affects one’s quality of life. Chronic health conditions often are not addressed well because ADHD symptoms—impulsivity, forgetfulness, inattention, and poor self-regulation—frequently make it hard to manage one’s health. This can lead to a shorter lifespan for someone with poorly managed ADHD. The additional feelings of being stressed out can make personal health management even more difficult.
Finding a middle point between stressed and able
It’s important to address both the cognitive challenges and the emotional challenges of combined ADHD and stress. 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 by limiting decisions that need to be made and helping to automate daily life.
Other techniques include incorporating more exercise into your routine and developing personal hobbies. If you’re a parent, working with your spouse or co-parent to allow you more time on your own to unwind or pursue a hobby can also help reduce your stress levels. Meeting with a professional, such as mental health practitioner or a coach, depending on your needs, can also help you to create ways of managing stress and ADHD symptoms together.