ADHD & The Interest Based Nervous System

ADHD brains are motivated by novelty, urgency, challenge, or interest. This is why boring, everyday tasks (like showering or brushing your teeth) can be so difficult to complete. People without ADHD or executive dysfunction have the proper neural wiring and neurotransmitters to complete these tasks without much effort, but for ADHD brains these tasks are much harder than even the most difficult task.

The concept of an interest-based nervous system was coined by Dr William Dodson. He explains that “a person with an interest-based nervous system must be personally interested, challenged, find it novel, or urgent right now or nothing happens.” It is either ‘I must do this right now’, or procrastination. This is the case among individuals with ADHD.

It differs from the importance-based nervous system, which is often how neurotypical brains are programmed. This system allows individuals to complete tasks according to their importance, which may not be immediate and may be important to someone else (e.g. a boss) rather than themselves. They are also able to prioritize the tasks and complete them in order of priority. They are motivated by rewards and consequences, such as knowing they won’t get a refund if they don’t return a parcel.

 Understanding the interest-based nervous system means that individuals can adapt tasks to fit into one of the four motivators, in order for tasks to be completed.

Novelty:

• How can you make the task seem new?
  e.g. come up with a new routine to follow until it becomes old, then make a new one.

• Find a new way to complete the same task.
  e.g. try making dinner in a new way.

• Pair new things with old tasks.
  e.g. listen to a new podcast or watch a new episode of a TV show whilst getting ready or leaving the house.

Interest:

• How can you adapt the task to fit your interests or link it to your interests?
  e.g. if you like creating things but hate cooking, create a recipe book of each meal that you make.

• Make the task itself seem more interesting.
  e.g. use nice stationary or pretty highlighters when reading a report.

• Do something else at the same time that interests you.
  e.g. listen to your favorite music.

Urgency:

• How can you make the task seem more urgent?
  e.g. try to introduce fake deadlines

• Introduce fake consequences for not meeting deadlines
  e.g. get someone to hold you to account and say if you don’t do x by x time, then they won’t make you dinner etc.

• Incentivize yourself to complete tasks.

Challenge:

• How can you make the task seem like more of a challenge?

• Turn the task into a competition or game.
  e.g. compete with your partner to see who can empty the dishwasher faster

• Challenge yourself
  e.g. challenge yourself to wash x amount of dishes in 10 minutes, or record the number and try to beat yourself the following day.

YOU ARE NOT ALONE! Remember to be patient with yourself and celebrate every small victory along the way. Give yourself some grace – and follow these tips – and you’re sure to see a change over time!

Premenstrual Dysphoric Disorder and ADHD

A woman’s mental health can be dramatically affected by alterations in the natural fluctuation of hormones that occur during the menstrual cycle. The dips in estrogen after ovulation and right before your period can lead to worsened ADHD and PMDD symptoms. As can the drastic changes in your progesterone levels across your luteal phase. Further, the peaks of estrogen prior to ovulation and mid-luteal phase can lead to increased histamine and worsened PMDD symptoms. Read more to learn why:

Why do these hormone changes affect some women more than others?

Premenstrual dysphoric disorder (PMDD) is a more serious and debilitating form of premenstrual syndrome (PMS) that is more likely to affect neurodivergent women. PMDD is defined by debilitating affective and physical symptoms that affect women during the luteal phase of their menstrual cycle including:

·        Depressed mood, sadness, hopelessness, worthlessness, decreased interest in normal activities

·        Increased anxiety, tension, or the feeling of being on edge

·        Mood swings, Increased irritability, anger, or both

·        Self-critical thoughts, increased sensitivity to rejection

·        Frequent or sudden tearfulness

·        Conflict with family, coworkers, or friends

·        Concentration problems

·        Fatigue, lethargy, or lack of energy

·        Changes in appetite, such as binge eating, overeating, or craving certain foods

·        Changes in sleep pattern, such as excessive sleeping or difficulty sleeping

·        Feelings of being overwhelmed or out of control

·        Physical symptoms: breast tenderness, headaches, joint/muscle aches, weight gain, bloating

If you have these symptoms, consider using this screening tool to learn more.

Causes of PMDD Symptoms

Premenstrual dysphoric disorder (PMDD) is under-researched and not fully understood, but it is thought to be caused by numerous factors that affect your brain’s neurochemistry and communication circuits (e.g., hormones, inflammation, stress, genetics, sensitivity to hormones and hormonal changes). Sufferers typically notice severe mood changes one to two weeks before the start of their period, that resolve within a few days after their period arrives.

PMDD is linked to unstable progesterone concentrations and may also reflect a hypersensitive or abnormal reaction to changes in progesterone and estrogen. Further, the changes in hormone levels across your cycle can lead to debilitating PMDD symptoms by affecting important neurotransmitters such as serotonin and dopamine.

Changes in progesterone levels can alter one’s mood and sense of well-being. Further, progesterone can decrease dopamine in the prefrontal cortex, which can modulate emotional responses. Decreased dopamine in the prefrontal cortex is already a problem among those with ADHD, making emotion regulation (e.g., irritability, anger, mood swings) and executive dysfunction symptoms worse for those with PMDD.

 Serotonin is an important contributor to well-being, playing a role in sleep, sexual behavior, mood, and cognitive functions. Estrogen promotes synthesis, prevents degradation, inhibits the reuptake of serotonin, and promotes the expression of serotonin receptors. Thus, estrogen plays a large role in the overall mood of women. Drops in estrogen mid-cycle and right before your period can lead to a serotonin deficiency.

Furthermore, estrogen increases dopamine synthesis and decreases its degradation and reuptake. It improves working memory, decision-making, and pleasure. Thus, the dips in progesterone and estrogen during your cycle affect dopamine availability in the prefrontal cortex and both dopamine and serotonin throughout the brain. Accordingly, some people may feel worse after ovulation when estrogen and progesterone are low, then feel a bit better during their mid-luteal phase, and worse again when both drop near the start of their period. Still others may be sensitive to progesterone changes and may feel the effects of PMDD across their full luteal cycle (~15 days).

 Other Complicating Factors: Mast Cells and Histamine

Mast cells are a type of white blood cell, one of our immune cells, with different receptors that can bind different things and trigger the release of its contents, histamine being one of them. Histamine is an immune signaling amine and a neurotransmitter. Histamine, in its role as a neurotransmitter, works to control the sleep-wake cycle. It is excitatory and can increase norepinephrine and epinephrine levels, leading to anxiety and insomnia. As an immune signaling amine, histamine is released by mast cells. Histamine may then be received by four different receptors (H1 through 4), playing many roles in the body and brain.

Histamine has a strong connection to our hormones through mast cells. Mast cells have a receptor for estrogen which stimulates the release of histamine and down-regulates the DAO enzyme that clears histamine. Histamine release can then stimulate the ovaries to make more estrogen, resulting in what can be a vicious cycle of estrogen → histamine → estrogen → histamine.

Individuals can have varying levels of tolerance to histamine. Those with lower tolerance or mast cell activation (more common in neurodivergence) may have elevations in measurable histamine that can cause the following symptoms: allergies/congestion, heart palpitations, cold/ heat intolerance, skin changes including itchy skin, flushing or hives, heavy/painful cycles, headaches, and breast tenderness.

If your histamine bucket is full or you are sensitive to changes in histamine, you may not tolerate estrogen fluctuations seamlessly. Accordingly, histamine symptoms are more common in women and often track with the menstrual cycle, occurring when estrogen is high at ovulation and then again in the mid-luteal phase a few days before your period. That’s why mid-cycle and premenstrual mood symptoms can be aided by antihistamines (e.g., H1 and H2 blockers). If taking antihistamines helps some of your symptoms, then histamine may be contributing to your PMDD symptoms.

It is important to track your symptoms daily for a few cycles to understand the unique response you have to these fluctuations in your hormones across your cycle. See more about PMDD, treatment resources, and tracking options here.

ADHD: Strategies for Improving Focus

• Work for shorter intervals of time and use a visual timer to help you see how much time you have left. Try to beat the timer by getting something done before you expected to (novelty and excitement help with focus).

• Breaks typically need only be a few minutes in duration. “Attentional breaks” are often best taken with a motor activity or a relaxing activity. For example, you might take a brief walk or run a short errand, or complete a few moments of mindfulness or progressive muscle relaxation. Limit phone use during your breaks.

• Use exercise either before or during your work activity when possible (e.g., slow pace on a desk treadmill)

• Create artificial deadlines for items that do not have deadlines to promote your completion of the task. For accountability, tell someone when you will have the item/project to them. For bigger projects, create mini-deadlines along the way. This can help boost confidence and keep you from feeling overwhelmed.

• Use body-doubling if working with others helps to motivate you (instead of distract you).

• Changing from one task to the next sooner can help restore your focus for a brief period of time. Tasks can be rotated such that you might work for 10 minutes on one task, 10 minutes on another task, and then return to work for another 10 minutes on the first task.

• Try the Pomodoro Technique: Set a timer for 20 minutes and begin working on your task. After 20 minutes, take a 5-minute break and repeat again. Give yourself a check mark for every cycle completed. The use of a Pomodoro timer might help with this task. More information about using a Pomodoro timer can be found at: https://pomofocus.io

• Limit distractions by putting your phone on silent or not checking notifications for the 10 minutes you are working. Check notifications on your breaks.

• Lengthy tasks, particularly those that are tedious or monotonous, should be interspersed with more frequent breaks or other, more engaging tasks.

• Use visual organizers such as pictures, schedules, planners, or calendar boards, which can help to establish and anticipate the routine for the day.

• Create a reward system for yourself and accountability with your partner for time spent focused at work and activities accomplished.

• Reframing: Combat unhelpful thought patterns by reframing tasks in a positive or more realistic way. For instance, if you are delaying beginning a project and your initial thought is, “there’s so much work it’ll take forever,” try checking yourself with a less negative and more realistic thought like, “if I begin this today, I’ll feel better, and there will be less work tomorrow.”

• Positive Self-talk: Meet your negative inner voice with an encouraging one. Try phrases like “I tried my best and that’s enough”,  “nothing is perfect, it’s ok to be human”, or “I am strong, capable, and I can get through anything.”

• Phones are one of the biggest distractions, especially for people with ADHD. Use a timed lock box to put away your phone when you have important tasks to do! Tik Tok will still be there when you’re done.

• Get stimulated: ADHD minds often feel understimulated which can lead to dropping boring tasks for more exciting ones. Add in a fidget spinner, soothing music, slime, exercise, a podcast or anything that helps you get going. It’s perfectly ok to pair activities as long as it helps you move closer to your goal.

• Eat protein-rich foods and foods rich in Omega-3s.

• Rule out medical causes of inattention such as anemia, vitamin D, and magnesium deficiencies that make ADHD symptoms worse.

• Practice meditation daily, even for just a few minutes, to increase your ability to focus via neural changes.

• Complete harder tasks at your best time of day and save easier tasks for when you are hitting a wall. For example, you may start your day with tasks requiring greater focus if you tend to fatigue in the afternoon.

• For tasks where you are not sure where to get started, seek support or input from others about your approach.  

ADHD is so much more than the inability to focus on non-preferred activities! It can be debilitating but there is help and hope, learn more here.

Coping with Rejection Sensitive Dysphoria

Rejection-sensitive dysphoria (RSD), while not a formal diagnostic category, describes experiences that often occur among those with ADHD. RSD reflects an increased sensitivity to rejection, real or imagined, as well as a greater tendency to perceive rejection even in neutral situations. RSD can be extremely painful and lead to intense suffering among those who experience it. Further, RSD thrives in an information vacuum, in us not knowing what others think about us, our work, and our place in the world. Read on to learn more about coping with RSD.

 Understanding RSD

Many neurodivergent individuals can recall every intense moment of hurt and rejection they have experienced like it was yesterday. Those with RSD are often haunted by past hurts/rejection. They also remain on guard for future rejection, so much so that they sometimes perceive rejection or criticism, where there is none, or have a response that others deem an over-reaction, not understanding the deep pain it has caused. RSD can also reflect a personal belief that you have let someone down. Because many ADHD children and adults may already experience a feeling of otherness, these slight rejections hurt all the more.

As a result, many neurodivergent people develop into people pleasers and perfectionists, going to great lengths to attempt to avoid rejection. They may also tend to ruminate after interactions with others, replaying events over and over in their head, or seeking reassurance from others that what they said or did was okay. This can lead to obsessions, shame, stress, humiliation, feelings of otherness, loneliness, and sadness.

Why does this happen? As humans, we are biologically wired for connection and acceptance, so rejection/criticism is viewed by our brains as a deadly threat, cueing your survival response! Think fight, flight, freeze, and fawn! Further, the emotion regulation challenges that come with ADHD, as well as previous experiences of rejection that come with neurodivergence, make it all the more painful.

Having ADHD and Rejection Sensitive Dysphoria does not make you a human who is weak or incapable. You are just wired to feel things more intensely and replay unpleasant interpersonal interactions over and over because RSD is linked to social insecurity. But empowered with the knowledge about how and why this happens, and the tools below, you can work to overcome RSD. Here are some great tips to help you work with rejection sensitivity and reduce its tumultuous effects in your life.

Believe In Yourself And Focus On Your Strengths

If you’re struggling to cope with rejection sensitivity, it can help to focus on your strengths. Remind yourself of your accomplishments and the things you’re proud of. If someone asked your loved one what was so special about you, what would they say? What about what you love to do? Or what you do well? If you struggle to identify strengths, ask the loved ones in your life. Whatever your strengths may be, make sure to focus on them regularly. This will help you to feel good about yourself and to build up your self-confidence.

Reframe Your Thinking and Work to Stop Taking Things Personally

Many adults with ADHD struggle to separate when a statement is directed specifically at them or when it’s something more general. They often take things personally that may not be personal. Remember that other people can say thoughtless or hurtful things sometimes that are more about them than you. The rejection you perceive may not be purposeful or personal. Instead of seeing rejection as a personal failure, try to see it as an opportunity to learn and grow, or a reflection of someone’s issues rather than your own. This will help you to accept failures and setbacks as a normal part of life, rather than taking them personally.

Develop Affirmations

One helpful strategy is to develop affirmations. Developing mantras or affirmations assists in reducing the noise of negative thoughts that can come with Rejection Sensitive Dysphoria. These are positive statements that help you to reframe your thinking and feel better about yourself. Affirmations can be short or long, but the important thing is that they’re meaningful to you. So take some time to think about what would help you to feel better in situations where you’re feeling rejected. Then start using those affirmations on a daily basis, both in your head and out loud. With time, you’ll find that they make it easier for you to deal with rejection in a more constructive way. Try positive phrases like: “I am stronger than I think.” “My mind is uniquely wired and creative.” “I can make a mistake and be a good person.” “I can take risks and see what happens.”

Build Supportive Relationships and Lean into Your Supports

Focus on building strong relationships with people who will support, encourage, and care for you, even when times are tough. These relationships will provide a buffer against the pain of rejection.

These people can provide a listening ear when you need to vent about a rejection. They can also help you identify if it was a real or just a perceived rejection and help you to see the situation in a more positive/balanced light. With the right support in place, you’ll be better equipped to deal with rejection and move on from it.

Ditch The Negative Self Talk and Replace it with Self-Compassion

It’s easy to get caught up in a negative feedback loop when you have ADHD. You feel like you can’t focus, so you get behind. Then you berate yourself for being “lazy,” which makes it even harder to focus. But the truth is, ADHD is a real neurological condition that makes it difficult to focus and stay organized. It’s not your fault. It’s important to ditch the negative self-talk and give yourself some credit for managing your ADHD. Remember that you are capable and competent, even if you sometimes have trouble staying on task or make mistakes and you have your own unique strengths that compliment your unique challenges. Be patient with yourself and give yourself grace when you make mistakes. Then, celebrate your accomplishments.

Give Yourself At Least One Positive Piece of Feedback Each Day

Give yourself at least one positive piece of feedback each day. For example, you might tell yourself that you did a good job of staying on task during a meeting, or that you handled a difficult situation well.

Stop The Comparison Cycle

Everyone has their own unique set of strengths and weaknesses. However, when you are neurodivergent, it can be all too easy to focus on your shortcomings and compare yourself to others.

This can lead to feelings of inadequacy and low self-esteem. One way to boost your self-esteem is to break the comparison cycle. Instead of comparing yourself to others, focus on your own unique gifts and talents. Celebrate your successes and remind yourself that you are just as worthy and deserving as anyone else. Also, keep in mind that when you are comparing yourself to others, you are not getting the full picture of that person as everyone has different challenges that are not always visible to others.

Give Yourself A Sense Of Control In Your Life

When you live with ADHD, it can often feel like you are out of control. Your thoughts may race, making it hard to focus, and you may feel impulsively drawn to activities that are not productive. This can lead to a sense of powerlessness. One of the most important things is to create structure for yourself.

This may mean setting regular times for breakfast, lunch, and dinner; making a daily schedule for yourself; or setting aside time each day for exercise. By creating structure, you will be able to stick to a routine and avoid the feeling that your life is spinning out of control.

Find Your Passions

Searching for your passion in life can be tough. But if you have ADHD, it’s important to find something that lights a fire inside of you. When you’re passionate about something, you pour your heart and soul into it. This blood, sweat, and tears approach not only makes you feel good about yourself, but it also builds character and resilience.

YOU ARE NOT ALONE! Remember to be patient with yourself and celebrate every small victory along the way. Building your self-esteem, changing your negative self-talk, and learning to cope with RSD is a process and won’t happen overnight. Give yourself some grace – and follow these tips – and you’re sure to see a change over time!