Strengths of ADHD

Dopamine Reward Pathway 

One of the most significant differences between an ADHD brain vs. a 

normal brain is the level of norepinephrine (a neurotransmitter).

Norepinephrine is synthesised from dopamine. Since the two go hand-in-hand, 

experts believe that lower levels of dopamine & norepinephrine are both linked to ADHD.

An imbalance in the transmission of dopamine in the brain may be associated 

with symptoms of ADHD, including inattention and impulsivity.

This disruption may also interfere with the changing how the ADHD brain 

perceives reward and pleasure.

Two fundamental kinds of brain signalling in ADHD

Bottom-up signals

• Definition: Automatic, fast, sensory-driven input from the environment. Stimuli capture attention without much conscious effort.
• Brain systems involved: Subcortical circuits (striatum, amygdala, sensory cortices), the salience network, and dopaminergic reward pathways.
• In ADHD:
  • The brain may be hyper-responsive to novelty and immediate rewards, leading to distractibility.
  • Emotional stimuli can drive behaviour strongly, contributing to impulsivity and mood lability.
  • Heightened salience detection can make irrelevant stimuli feel equally important as relevant ones.

 Top-down signals

• Definition: Goal-directed control exerted by higher-order brain areas to regulate behaviour, filter distractions, and maintain focus.
• Brain systems involved: Prefrontal cortex (especially dorsolateral and anterior cingulate cortex), frontoparietal control network.
• In ADHD:
  • Weaker or inconsistent regulation of attention, working memory, and inhibition.
  • Difficulty maintaining focus on tasks without immediate payoff.
  • Less efficient suppression of irrelevant bottom-up inputs.

The imbalance in ADHD

• Normally, top-down control dampens bottom-up noise, allowing attention to remain on task.
• In ADHD:
  • Bottom-up signals dominate (novelty, rewards, emotions pull focus).
  • Top-down control is underactive or inconsistent, due to differences in prefrontal networks and dopamine signalling.
  • This mismatch explains why ADHD brains can be distractible in boring contexts but hyperfocused when bottom-up salience and motivation align (e.g., video games, urgent tasks).

Brown, T. E. (2006). Executive functions and attention deficit hyperactivity disorder: Implications of two conflicting views. International Journal of Disability, Development and Education, 53(1), 35–46.

Executive functions is the name given to the mental processes that people rely on to control themselves and get things done, even when they find the required task boring or tedious, and the reward for effort is delayed.

They involve the mental processes people rely on to monitor and regulate their thoughts, words, actions and emotions. They also assist people to self-motivate and take willful action, to perceive and manage time, and to direct and manage their behaviour over time.

Every time we think, we engage our executive functions — a set of cognitive processes that allow us to plan, organise, remember information, and initiate action on a goal. 

Cluster 1. Activation

Organising, prioritising, and getting started on tasks

• Trouble organising tasks and materials
• Chronic procrastination, waiting until urgency/punishment to start
• Difficulty following instructions and keeping track of tasks
• Daydreaming or rushing through work

Cluster 2. Focus

Focusing, sustaining, and shifting attention

• Difficulty sustaining focus, especially for boring tasks
• Easily distracted by external or internal stimuli
• Trouble shifting between tasks when required
• Reading comprehension issues (re-reading to retain meaning)

Cluster 3. Effort

Regulating alertness, sustaining effort, and processing speed

• Good at short bursts, but struggle with long-term sustained effort
• Slower processing and reaction time
• Difficulty completing tasks consistently or on time
• Sleep regulation problems: staying up late, difficulty waking, daytime drowsiness
• Trouble persisting when tasks get harder

Cluster 4. Emotion

Managing frustration and modulating emotions

• Not recognised in DSM-5, but very common in ADHD
• Emotional reactions feel overwhelming and hijack attention
• Struggles with frustration, anger, disappointment, worry
• High sensitivity to criticism, irritability, unhappiness

Cluster 5. Memory

Using working memory and accessing recall

• Forgetfulness in daily routines (losing items, forgetting instructions)
• Hard to hold multiple things in mind while working
• Good recall for distant memories, poor short-term recall
• Struggles retrieving learned information when needed

Cluster 6. Action

Monitoring and self-regulating behaviour

• Impulsivity in speech, actions, and thoughts
• Poor context monitoring (noticing social cues)
• Trouble adjusting behaviour in real time
• Restlessness, interrupting, careless mistakes, disruptiveness
• Difficulty regulating pace (too fast/too slow)

Clinical Studies on effectiveness of long acting stimulant medication for ADHD

These medicines are called stimulants because they increase the brain 

chemicals dopamine and norepinephrine.  

They are a central nervous system stimulant prescription medicine. 

These medications are Schedule 8 medicines which are subject to strict legislative controls due to their high potential for misuse, abuse and dependence. 

They come in 2 forms; long acting & short acting 

Long acting 

Takes from 45-90 mins to work

Lasts from 8-12 hours

One a day

Doses from 20mg to 70mg

This medication is Vyvanse

Vyvanse Patient Information 

Vyvanse Clinical Information 

Detailed medication data can be found here 

Covered on PBS $31.60 for 30 days

Short acting

Takes around 30 mins to work

Lasts from 3-4 hours

Multiple doses per day, upto a max of 8 tablets per day

5mg dose

This medication is Dexamphetamine 

Clinical trials highlighting effectiveness and safety

Long-lasting medicines are usually the most practical option because people with ADHD may have trouble remembering to take their medicine.

They also provide steady symptom relief throughout the day. By contrast, if you use short-acting stimulants, your symptoms may return between doses. Some people “crash” as their short-acting dose wears off, meaning their energy and mood drop.

In ADHD, the brain region prefrontal cortex (responsible for planning, focus, and impulse control) and their networks with the striatum and basal ganglia don’t regulate dopamine and norepinephrine efficiently.

• This leads to inconsistent attention, difficulty sustaining focus, impulsivity, and problems with motivation.
  
  
• Mechanism:
  • Increase dopamine and norepinephrine levels in synapses.
  • Block reuptake transporters (so neurotransmitters stay active longer).
  • Amphetamines also increase release of dopamine and norepinephrine from neurons.

• Effect:
  • Boosts signal strength in the prefrontal cortex, leads better sustained attention, working memory, and self-regulation.
  • Reduces “background noise” in the brain so relevant information is easier to focus on.

How ADHD medication works: click here for more details

Mechanism of action of long acting Vyvanse

Studies on Safety of Vyvanse medication: 

Coghill, D.R., Caballero, B., Sorooshian, S. et al. A Systematic Review of the Safety of Lisdexamfetamine Dimesylate. CNS Drugs 28, 497–511 (2014)

For most people with ADHD, many genetic and environmental risk factors accumulate to cause the disorder (Faraone et al., 2015).

The environmental risks for ADHD exert their effects very early in life, during the fetal or early postnatal period. In rare cases, however, ADHD-like symptoms can be caused by extreme deprivation early in life (Kennedy et al., 2016), a single genetic abnormality (Faraone and Larsson, 2018), or traumatic brain injury early in life (Stojanovski et al., 2019).

These findings are helpful to understand the causes of ADHD but are not useful for diagnosing the disorder.

The associations between aspects of the environment and the onset of ADHD have attained a very high level of evidential support. Some have strong evidence for a causal role but, for most, the possibility remains that these associations are due to correlated genetic and environmental effects.

For this reason, we refer to features of the pre- and post-natal environments that increase risk for ADHD as correlates, rather than causes. 

The genetic and environmental risks described below are not necessarily specific to ADHD.

ADHD can also be the result of rare single gene defects (Faraone and Larsson, 2018) or abnormalities of the chromosomes (Cederlof et al., 2014). When the DNA of 8000+ children with autism spectrum disorder (ASD) and/or ADHD and 5000 controls was analyzed, those with ASD and those with ADHD had an increased rate of rare genetic mutations compared with controls (Satterstrom et al., 2019).

A review of 37 twin studies from the United States, Europe, Scandinavia, and Australia found that genes and their interaction with the environment must play a substantial role in causing ADHD (Faraone and Larsson, 2018; Larsson et al., 2014a; Pettersson et al., 2019).

In a genomewide study, an international team analysed DNA from over 20,000 people with ADHD and over 35,000 without ADHD from the United States, Europe, Scandinavia, China, and Australia. They identified many genetic risk variants, each having a small effect on the risk for the disorder (Demontis et al., 2019).
This study confirmed a polygenic cause for most cases of ADHD, meaning that many genetic variants, each having a very small effect, combine to increase risk for the disorder. The polygenic risk for ADHD is associated with general psychopathology (Brikell et al., 2020) and several psychiatric disorders (Lee et al., 2019a,b

Family, twin, and DNA studies show that genetic and environmental influences are partially shared between ADHD and many other psychiatric disorders (e.g. schizophrenia, depression, bipolar disorder, autism spectrum disorder, conduct disorder, eating disorders, and substance usedisorders) and with somatic disorders (e.g. migraine and obesity) (Demontis et al., 2019) (Faraone and Larsson, 2018) (Ghirardi et al., 2018) (Lee et al., 2019a,b) (Lee et al., 2013) (Anttila et al., 2018; Tylee et al., 2018) (van Hulzen et al., 2017) (Vink and Schellekens, 2018) (Brikell et al., 2018) (Chen et al., 2019a) (Yao et al., 2019).

However, there is also a unique genetic risk for ADHD.

Evidence of shared genetic and environmental risks among disorders suggest that these disorders also share a pathophysiology in the biological pathways that dysregulate neurodevelopment and create brain variations leading to disorder onset.

Very large studies of families suggest that ADHD shares genetic or familial causes with autoimmune diseases (Li et al., 2019), hypospadias (Butwicka et al., 2015), and intellectual disability (Faraone and Larsson, 2018).

Understanding ADHD Burnout: Causes, Symptoms, and Coping Strategies

Living with ADHD (Attention Deficit Hyperactivity Disorder) means navigating a brain that works differently. While it comes with strengths—like creativity, energy, and unique problem-solving—it also brings daily challenges around focus, organization, and emotional regulation. Add in the constant pressure to keep up in a fast-paced world, and many people with ADHD eventually hit a wall: ADHD burnout.

This type of burnout is often misunderstood, but it’s a very real and overwhelming experience. 

Let’s dive into what it is, why it happens, and how to recover when you feel completely drained.

What Is ADHD Burnout?

ADHD burnout is a state of mental, emotional, and physical exhaustion. It happens when someone with ADHD pushes themselves too hard—often trying to meet external expectations—while also managing the everyday demands that ADHD makes harder.

Some of the key drivers include:

• Constant overwhelm from tasks that feel impossible to finish
• Pressure to “keep up” with neurotypical peers
• The heavy mental load of masking symptoms in work or social settings
• Lack of rest, self-care, or proper support

Over time, this pressure adds up, leaving you feeling depleted, stuck, and hopeless.

Causes of ADHD Burnout

There isn’t just one reason ADHD burnout happens—it’s usually a mix of factors. Here are some of the most common:

Cognitive Overload

Because ADHD impacts executive function, everyday tasks like planning, prioritizing, or meeting deadlines require extra effort. That constant mental strain leads to fatigue.

 Hyperfocus (and the Crash After)

When someone with ADHD locks into a task, they can work for hours straight—forgetting meals, breaks, or rest. Eventually, the body and brain crash, creating burnout.

Inconsistent Motivation

Tasks that feel boring can be almost impossible to start, while interesting ones may lead to overwork. That rollercoaster creates stress and imbalance.

Social and Emotional Stress

ADHD often comes with feeling misunderstood, judged, or “not enough.” Social interactions can feel draining, and emotional stress compounds the burnout cycle.

Masking

Trying to hide ADHD traits in professional or social settings takes huge effort. Over time, that performance is exhausting.

Sleep Struggles

Many people with ADHD wrestle with insomnia, racing thoughts, or irregular sleep patterns. Poor rest makes recovery from burnout even harder.

Signs and Symptoms of ADHD Burnout

ADHD burnout can look different for everyone, but some common signs include:

• Emotional exhaustion – feeling empty, drained, or numb
• Difficulty prioritizing – getting stuck, unable to decide what to do first
• Physical fatigue – tired no matter how much you rest
• Impulsivity – turning to quick “escapes” like shopping, eating, or scrolling
• Social withdrawal – avoiding people because it feels overwhelming
• Brain fog – struggling to concentrate, even on things you enjoy
• Mood swings or irritability – snapping over small things
• Declining performance – work, school, or relationships start to suffer
• Hopelessness – believing you’ll never “catch up”

Coping Strategies: How to Recover from ADHD Burnout

The good news is: recovery is possible. It takes patience, self-compassion, and strategies that work with your ADHD brain—not against it. Here are some steps to help you reset:

1. Recognize the Signs Early

Burnout sneaks up on you. Noticing the red flags (irritability, brain fog, emotional fatigue) gives you a chance to pause before things get worse.

2. Lower the Bar

Set realistic expectations. Perfectionism and impossible standards feed burnout—aim for “good enough” instead of “perfect.”

3. Use ADHD-Friendly Tools

• Break tasks into smaller steps
• Use timers (Pomodoro method works well)
• Create visual reminders like task boards or sticky notes

4. Build in Breaks

Schedule downtime the way you would schedule a meeting. Your brain needs recovery time.

5. Practice Self-Compassion

ADHD isn’t about laziness or weakness—it’s neurological. Speak to yourself kindly and give yourself permission to rest.

The Importance of Grieving the diagnosis of ADHD

This video talks about how grief can present shortly after a diagnosis of ADHD.
Grief for possible missed opportunities in all areas of life, as a consequence of ADHD.

This video the Grief of Wasted Time explores this is more detail.

Common ADHD Symptoms in Teenage Boys

Oppositional Defiant Disorder video 

By Dr Barkley 

1. Procrastination

Teen boys with ADHD often delay starting tasks, especially those requiring sustained effort or that feel boring (like chores, assignments, or study). This is linked to dopamine dysregulation, which makes them seek stimulation and avoid low-reward activities.

2. Impulsivity

Hyperactive-impulsive teens may act without thinking: interrupting, struggling to wait, blurting out answers, or engaging in risky behaviors (reckless driving, unsafe sex, impulse buying). These actions happen “in the moment” without weighing consequences.

3. Careless Mistakes

They often miss details—spelling errors, incomplete assignments, or errors in maths—not because of low intelligence, but due to inattention and distractibility.

4. Restlessness

ADHD teens can feel constantly “on the go,” unable to sit still for long. This may be expressed as fidgeting, pacing, or needing to move during class.

5. Sensitivity to Criticism

Many experience rejection sensitivity dysphoria (RSD), where even mild criticism or perceived rejection can feel overwhelming, sometimes leading to anger, sadness, or withdrawal.

6. Difficulty Sustaining Long Tasks

Lengthy or complex projects are challenging due to “time blindness” (struggling to track how long something takes) and reduced working memory. They often start tasks but fail to complete them.

7. Disorganization

Belongings are often misplaced, rooms messy, assignments forgotten, and personal hygiene neglected. This stems from executive dysfunction—difficulties with planning, sequencing, and follow-through.

8. Emotional Dysregulation

Mood swings, irritability, or angry outbursts are common. Emotional intensity tends to be stronger than in neurotypical peers, and recovery after upset can take longer.

9. Forgetfulness

Short-term memory lapses are frequent—forgetting homework, deadlines, appointments, or even parts of conversations.

10. Hyperfocus

Paradoxically, teens may become intensely focused on a topic of interest (e.g., gaming, sports stats, creative hobbies). This can lead to neglect of other important responsibilities.

11. Sleep Problems

They may struggle to fall asleep, resist bedtime, or find mornings especially difficult. Sleep disturbances worsen inattention and irritability.

12. Social Cue Difficulties

Teens with ADHD can miss facial expressions, tone, or body language, making peer relationships harder. Misinterpretations can lead to conflict or isolation.

13. Daydreaming 

More common in inattentive ADHD, teens may “zone out” in class or conversations, physically present but mentally elsewhere.

Do ADHD Symptoms Get Worse During Puberty?

Yes—puberty often intensifies ADHD symptoms due to:

• Hormonal changes: Fluctuating testosterone and estrogen affect neurotransmitters like dopamine and norepinephrine, which are already dysregulated in ADHD. This can heighten impulsivity, hyperactivity, and mood swings.
• Brain development: The prefrontal cortex (responsible for planning, decision-making, and self-control) is still developing. This lag makes executive functioning demands harder during adolescence.
• Increased demands: Academic pressures, more complex social environments, and rising expectations at home and school place greater strain on executive skills.
• Emotional shifts: Teens face identity development, peer comparison, and independence struggles, which compound ADHD-related challenges.

Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant challenges in self-management, including organisation, planning, initiating and completing tasks in a timely manner, shifting between activities, self-monitoring, and inhibiting responses.

Article: A second mental health presentation along with ADHD 

These skills are collectively described as executive functions (EFs), which can be viewed as “those self-directed actions needed to choose goals and to create, enact, and sustain actions toward those goals” (Barkley, 2012).

When executive functions are impaired, individuals typically struggle with reduced productivity, inefficiency, missed deadlines, poor planning, disorganisation, “careless” errors, and frequent loss or forgetting of items. For some—particularly those with the combined presentation of ADHD—reduced inhibitory control can also manifest as emotional dysregulation and inappropriate verbal or physical behaviour in interpersonal contexts.

Over the lifespan, these difficulties contribute to repeated failures to achieve goals personally, academically, and occupationally. Such persistent struggles often increase the risk of secondary anxiety and depression, which are highly prevalent in adults with ADHD.

Clinical Framing: Executive Functioning Deficit Disorder

Our diagnostic clinical assessment is undertaken through a semi-structured clinical interview, which explores ADHD symptoms as manifestation of executive functioning deficits.

ADHD is understood as a neurodevelopmental disorder characterised by executive dysfunction, impairing the brain’s ability to select, monitor, and regulate behaviour in pursuit of goals.

Executive dysfunction affects:

• Task management and planning
• Time awareness and scheduling (time blindness)
• Goal setting and persistence
• Concentration and resistance to distraction
• Working memory, organisation, and self-monitoring
• Self-inhibition and attentional shifting

From this perspective, ADHD is best conceptualised as a disorder of self-regulation rooted in EF impairment.

Misleading Terminology

The term “Attention Deficit” is misleading, as it obscures the broader self-regulatory impairments that characterise ADHD. Similarly, “Hyperactivity”—while valid in describing childhood behaviour—does not capture the adult presentation. Adults are not “hyperactive” in the same way as an 8-year-old boy; instead, impulsivity better reflects the adult clinical profile. Impulsivity has clear potential for negative consequences in decision-making, relationships, and occupational functioning.

Gender Bias and Diagnostic Inadequacy

Current diagnostic criteria and terminology are insufficient and discriminatory when applied to women and adolescent girls. Symptoms in these groups often manifest less in disruptive behaviour and more in internalised difficulties such as disorganisation, emotional dysregulation, rejection sensitivity, and cognitive/verbal impulsivity. These differences have contributed to widespread under-recognition and late diagnosis in women.

A more accurate diagnostic approach reframes ADHD as a broader Executive Functioning Self-Regulation Deficit Disorder, particularly in women, encompassing:

• Emotional dysregulation and rejection sensitivity
• Cognitive, verbal, and behavioural impulsivity
• Persistent executive functioning challenges across domains