If you’re ADHD or AuDHD, you know that feeling when someone suggests a new productivity system to you.

Inside, you’re laughing at their foolish optimism about your executive functioning abilities.

As if they were the chosen one, sent to save the ADHDers with the one planning system that beats all the others that never made it past week one.

They present a fabulous Notion template with an amazing database, multiple monthly, weekly, and daily views, so you can literally know everything you’re going to do for the next month. Everything will happen exactly as you planned it, and you’ll use this planner for the rest of your life, because someone finally made one that “works for ADHD.” 🙏

Unfortunately, that’s not how it works for us. It’s not that we haven’t found the right planning system. It’s that we can’t exist in the same reality as traditional planning systems.

Every time we try to implement a new one, we end up back at the same “system.”

For me, that is the Notes app on my iPhone.

In this piece, I’m going to explain why that doesn’t always work, and how we can lean into Notes to make it work better.

How I Currently Use the Notes App

Like many others who are ADHD or AuDHD, I’m great at capturing ideas. I write them down in my Notes app with all the excitement that comes with an idea being externalized mid-flow:

All of the possibilities of the idea are going through my head at the same time.

All of the different ways I could use it.

All of the different project ideas that could come from it.

And all of the directions it could take my life in that seem so much more fun and exciting right now than anything that I already had planned.

The problem with this system is that 99.99% of the notes will never be used, and I’m surprised that the chaos of them doesn’t break the Notes app.

The notes have notes. One note can contain almost anything a human could write. It can simultaneously be:

• An article idea

• A Substack Note idea

• The name of someone I absolutely have to remember

• The two things missing from my fridge, preventing me from being able to feed myself today

• A list of tasks that absolutely must be done according to the plan that was in my mind at the moment it was captured

There are two main problems with this chaotic system my AuDHD mind seems to love:

• I create a new note for most of the ideas I capture, so the app is just an endless stream of notes that only have meaning on the day I write them. They lose all meaning as they disappear into the abyss of the Notes list, joining all the other notes that came before them, half of which may have exactly the same title.

• I very rarely go and look through the previous notes I’ve written, so task lists go uncompleted, ideas go to waste, and the only thing I achieve is the externalization itself, rather than something I can actually use.

I have a really extreme idea for how to overcome this, and I’m going to start testing it this week. If you think it could work for you, please feel free to steal the idea, and let me know how it goes for you.

The Idea

I’m going to lean into the Notes app, because it seems to be the only thing I return to after each failed attempt to organize like everyone else.

But I’m going to try having specific Notes for specific things. I told you this would be a wild idea. Stick with me.

I will create the following Notes:

Inbox

This note will be the dumping ground for anything and everything (apart from article and Substack Note ideas). This is where all of the ideas and things I need to get done will be externalized as they come to my mind.

Next

This is the list of priority things to be done. I am absolutely not calling it “Today” or “Daily List,” because that would imply I’m supposed to look at it every day, and I’m not going to pressure myself like that.

It’s “Next” because when I feel like knowing what comes next, I can look at it, without expecting myself to function “normally” every day.

Article Ideas

I think it makes sense to have a separate note for article ideas, so they can be kept tidily on their own, and I can write ideas for each article under the topic directly in the note.

Substack Note Ideas

This is another idea type I have often enough that it makes sense to keep it separate, so I can manage it in one note, away from the mayhem of the Inbox. I will actually call it Note Ideas. I called it Substack Note Ideas here for clarity.

Notes Management

The way I hope this works: when something comes to mind that I know needs to get done, I add it straight to “Next.” That way, Next is just a list of urgent stuff I can cross off whenever I get time.

Hopefully I will go through the Inbox every now and then, when I feel like it, to see if anything needs moving to Next or just deleting. There is no point in setting a specific day for this every week, because it will then be too much like an organized system, and it won’t survive.

When I need to work out my next article, I will have a list there to look at, rather than trying to find the five different lists of article ideas I have across Notion.

I think you get the idea:

• Individual Notes for the types of ideas you have regularly (for me, articles and Substack Notes), so you can actually use them

• Next for your priority tasks list

• Inbox for everything else that comes into your head

I’m still not sure if this is too much like real organization for me, or if the balance between the randomness of Notes and the structure of only using four Notes will work. I’ll let you know!

I’m really keen to know how other ADHD and AuDHD people are managing this.

Please comment or restack with your experiences of this or suggestions for me.

Have a great week,

Rich

If you’re anything like me, your resume looks more like a long list of projects than a career.

Most of us who were diagnosed or identified late went through our careers on autopilot, not knowing why the environments and the interactions were so much harder for us than for everyone else.

Then we finally got the news that we are neurodivergent, and we were immediately made to feel like we were the problem. That our neurological profile is defective and needs fixing.

We were never the problem. We are not defective or disordered. We are natural variation in how brains work, and that variation comes with both challenges and strengths.

The difference between being beaten by the challenges and thriving on the strengths is down to your environment.

Unfortunately, because our neurological variations fall within the minority, those environments were not designed with us in mind.

That is the thing that needs to change, not us.

This is part two of a two-part series on neurodivergent workplace accommodations. Part one explained the case for accommodations.

This guide breaks down how to accommodate neurodivergent people in the workplace. It can also be used as an overview of what you can ask your employer for.

Accommodate Traits, Not Diagnoses

If you treat autism and ADHD as two neat separate categories, the way the medical system did until 2013 and still does in practice, you will not effectively accommodate neurodivergent people in your workplace.

To be specific, if you hand ADHD accommodations to everyone with an ADHD diagnosis, and autism accommodations to everyone diagnosed with that alone, you will miss a large part of what your people actually need.

Autism and ADHD are not two separate entities. In reality they are overlapping expressions of one spectrum of traits.

The research data on the overlap between the traits varies a lot, but roughly 50 to 70% of autistic people meet the criteria for ADHD (1), and roughly 20 to 50% of ADHD people also meet the criteria for autism (2).

The gap between the number of people who are both, and the number the medical system labels as both, is huge.

A US study of adults diagnosed as ADHD found that around 2% had been diagnosed as both (3). Compare that to the overlap statistics, and you can be fairly sure that most of your neurodivergent employees will not have been given their full picture yet by the medical system.

So before you work out how to accommodate the traits they already know about, give your neurodivergent employees the resources to understand all of their traits.

This is one resource that can help with that. It breaks down the criteria for both autism and ADHD in plain language.

The Law on Neurodivergent Accommodations

This is an overview of how the law works in the UK and the US. The main difference is that the UK puts the duty on the employer to notice and act, while the US waits for the employee to ask and then lets the employer request proof.

Neither system defines which accommodations you have to provide, but both attach a substantial penalty for getting it wrong. So the sensible move is to ask the neurodivergent people who need the accommodations, rather than guess and risk a tribunal.

UK: Equality Act 2010

• Who it covers: all employers, regardless of size.

• What has to be shown: an impairment with a substantial, long-term adverse effect on the ability to carry out normal day-to-day activities (4).

• Proof: no diagnosis is required, and the worker does not have to provide medical evidence (5).

• Who starts the process: the employer, once they know or could reasonably be expected to know.

• What the employer must provide: reasonable adjustments, which the law does not define or list.

• The limit: whatever counts as reasonable, judged on cost, practicality and the size of the business.

• If the employer fails: an employment tribunal claim for disability discrimination, with uncapped compensation.

US: Americans with Disabilities Act

• Who it covers: employers with 15 or more staff.

• What has to be shown: an impairment substantially limiting a major life activity. Autism sits on the EEOC list of conditions that will virtually always qualify (6). ADHD is not on that list and needs the standard individualized assessment, which it usually passes, because the ADA Amendments Act deliberately lowered the bar (7).

• Proof: the employer can require documentation from a health provider.

• Who starts the process: the employee, who has to request an accommodation.

• What the employer must provide: reasonable accommodation, which the law does not define or list.

• The limit: undue hardship, meaning significant difficulty or expense.

• If the employer fails: an EEOC complaint followed by a lawsuit. Back pay is uncapped. Compensatory and punitive damages are capped by headcount, from $50,000 at 15 to 100 employees up to $300,000 at over 500 (8).

This is a general overview rather than legal advice, and businesses should take proper legal advice before setting policy.

The Accommodations

This is an overview of the accommodations the research supports, broken down by trait. For neurodivergent people, this is what you can ask for. For business leaders, this is what you should agree to if you want to retain neurodivergent talent and avoid costly tribunals.

Not everyone will agree with every item on this list, but it is better to do too much to make your work environments accommodating than too little.

Attention and focus

The most consistent finding in the ADHD workplace research is not about any single accommodation. It’s about person-environment fit (9).

Workers reported that stimulating environments with novelty, autonomy, pace, and both communal and quiet spaces suited them well. Unsuitable environments made symptoms worse, which then damaged performance, job satisfaction and job tenure (9).

• Provide a quiet space, or the right to work somewhere quiet (9, 10). If you can’t provide this in the office, you should consider a remote work policy.

• Permit noise-canceling headphones, ear defenders or earplugs (5).

• Allow standing desks, movement and fidget tools (5).

• Protect focus blocks, no-meeting mornings, and keep communications asynchronous by default.

• Give warning before interrupting, rather than allowing people to be tapped on the shoulder mid-flow.

• Match tasks to interest wherever the role allows. Interest is not a luxury for us. It is the mechanism by which our attention engages at all.

Hyperactivity and impulsivity

The cost is not the fidgeting or the interrupting. It is the energy spent suppressing them, which is exhausting for ADHD individuals (9).

• Allow movement without explanation. Standing, pacing, walking meetings, and cameras off on calls (5).

• Shorten meetings, build in breaks, and cancel the ones a written update would replace (9).

• Give people somewhere to dump an idea the moment they have it, so the choice isn’t between interrupting and losing it.

• Invite input at intervals rather than expecting people to cut in.

• Match the work to the energy. The restlessness and the bias toward action stop being a problem in roles with pace and urgency, so launches, incident response and early-stage prototyping are where the same trait becomes the reason we’re good at the job (9).

Sensory processing

• Move people away from fluorescents, provide task lighting, and allow screen filters to reduce brightness (5, 10).

• In the office, provide quiet or private workspace. A corner of the open plan won’t be sufficient for this. A separate room is better (5, 9).

• A designated low-stimulus space to decompress in (5).

• Flex the dress code for fabric and comfort (5).

• Manage smells. A fragrance-free policy costs nothing.

• Remote or hybrid work, which removes the sensory load of the commute and the office in one move.

• The noise-canceling headphones also help with this.

Executive function

This includes task initiation, working memory, prioritization, and time management.

• Break work into smaller tasks with a clear order (5).

• Regular short check-ins for accountability. A ten minute daily stand-up beats a monthly review (5).

• Written instructions, always. Follow every verbal briefing with a written summary.

• Give explicit deadlines, including for things that are not urgent. With time blindness, no deadline means no timeline at all.

• Planners that visually surface deadlines, plus extra reminders (5).

• Assistive tools: checklists, timers, calendars, note-taking systems, templates, productivity software (9).

Deep focus and special interests

Hyperfocus shows up when the work is interesting, so engagement is the switch that turns it on.

• Give ownership of a domain rather than rotating everyone through everything.

• Align work with what engages us, because that is what turns the depth on. Detail that bores everyone else becomes absorbing once the subject matters to the person doing it (9).

• Protect the state once it arrives. A day broken up by meetings makes it impossible regardless of the work. Set aside deep work periods that are uninterrupted.

• Hyperfocus runs past sustainable limits, so end-of-day boundaries can matter more for us. Make sure that employees are getting enough rest and breaks, especially if they’re working from home where it might not be as obvious.

Communication and social interaction

• Say what you mean. Direct instructions, explicit expectations, and nothing important left between the lines.

• Offer written or asynchronous alternatives to meetings and calls.

• Make social events genuinely optional, and make sure opting out does not cost career capital.

• Train the team on the accommodations you’re implementing, and the reasons why. Peer awareness training was among the changes identified as making a real difference (10).

That last one is crucial. Everyone in the company needs this knowledge or the accommodations might not work, and may create tension that causes even more damage to people who are already struggling.

Emotional regulation and feedback

• Deliver feedback specifically and privately, focused on the work.

• Give it in writing so it can be processed rather than performed through.

• Separate “here is an adjustment” from “here is a performance concern.” Managers conflate these constantly and it is devastating. Granting an adjustment and raising a performance concern are two separate conversations, and merging them (or dropping the feedback entirely to be “kind”) punishes people for asking.

• Understand that rejection can land hard. Calibrate delivery accordingly instead of treating the reaction as the problem.

Predictability and change

• Advance notice of changes, plus time to process them (5).

• Explain the reasoning behind a change, not just the change itself.

• Clear role definitions and clear expectations.

Energy management

Neurodivergent workers are more likely to experience burnout, and employers should consider what support helps avoid it, such as extra breaks or varying the type of work (5).

• Build in recovery time as standard, rather than treating it as a reward.

• Watch total load, not just hours. Masking is unpaid labor and it is exhausting. If someone with sensory issues is forced into the office, their load will be higher than that of someone without.

• Treat absence patterns as a signal to ask what is not working, not as a disciplinary trigger.

• Make it safe to say “I am at capacity” without it being career limiting.

Make Disclosure Safe

Disclosure gets people better accommodations, more acceptance and more inclusion. It also exposes us to stigma and discrimination (10). Both of those are true at the same time, which is why the decision belongs to the individual and nobody else.

The employer’s job is to make the disclosure feel safe for the individual:

• A visible policy

• Adjustments available without diagnosis

• Confidentiality that is actually honored

• Neurodiversity training for all employees

I want your opinion.

Please comment with your feedback:

Did I miss anything here that you think could be useful?

Do these accommodations seem reasonable to you?

There are so many neurodivergent people who are not only struggling, but completely burned out after a career of masking, and “just pushing through.”

It doesn’t have to be like this.

It is possible for us to be accommodated at work, and we have unique skills to contribute.

The automation of routine tasks is drastically changing the shape of work. It’s becoming increasingly important to attract and retain talent that thinks differently, and can solve problems and create in unique ways.

That’s us.

Let’s make the decision of disclosure a no-brainer for future generations.

Have a great week,

Rich

References

1. Hours, C., et al. (2022). ASD and ADHD comorbidity: what are we talking about? Frontiers in Psychiatry, 13, 837424.

2. Rommelse, N. N. J., et al. (2010). Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. European Child and Adolescent Psychiatry, 19(3), 281–295.

3. Zaleski, A., et al. (2025). Real-world evaluation of prevalence, cohort characteristics, and healthcare utilization and expenditures among adults and children with autism spectrum disorder, attention-deficit hyperactivity disorder, or both. BMC Health Services Research, 25, 1048.

4. Equality Act 2010, c. 15, section 6. UK legislation.

5. Acas. (2025). Adjustments for neurodiversity: reasonable adjustments at work. Advisory, Conciliation and Arbitration Service. Government guidance.

6. US Equal Employment Opportunity Commission. Regulations to implement the equal employment provisions of the Americans with Disabilities Act, 29 CFR 1630.2(j)(3)(iii). Federal regulation.

7. US Equal Employment Opportunity Commission. Fact sheet on the EEOC’s final regulations implementing the ADAAA. Federal agency guidance.

8. Civil Rights Act of 1991, 42 U.S.C. §1981a(b)(3). Federal statute.

9. Hotte-Meunier, A., et al. (2024). Strengths and challenges to embrace attention-deficit/hyperactivity disorder in employment: a systematic review. Neurodiversity, 2.

10. Lindsay, S., et al. (2021). Disclosure and workplace accommodations for people with autism: a systematic review. Disability and Rehabilitation, 43(5), 597–610.

We’ve all heard the comments from family members or colleagues:

“She’s taking advantage of her autism so she can work from home.”

“It’s not fair on the other candidates if we give her accommodations for the interview.”

Some possible reasons for this:

1. A lack of knowledge on the neurodivergent workplace experience.

2. A lack of knowledge on the benefits of attracting and retaining neurodivergent talent.

3. A lack of empathy for the experience of others.

4. Straight up ableism.

Everyone is in categories 1 and 2 at some point in their lives, so this can be solved. I believe most people are kind, and that most of this comes down to a knowledge gap.

This article is my way of attempting to bridge this knowledge gap, and I hope that it reaches business leaders, and others in a position to make changes for us, and for themselves.

After all, it is not only neurodivergent people who benefit from being accommodated. It is also the businesses that are currently leaving neurodivergent thinking skills on the table.

This is part 1 of a two-part series.

Part 2 will be a detailed guide that explains how to benefit from accommodating neurodivergent people. This will include both:

• Guidance for businesses on how to design and implement accommodations that attract and retain neurodivergent talent.

• For neurodivergent people, this will indicate what accommodations they can ask for based on their particular neurodivergent traits.

The part 2 guide will be for free subscribers, so subscribe below to access that.

Once you’ve read this, if you feel like it might help you or someone you know at work, please restack and share it with your friends and colleagues.

The Neurodivergent Workplace Experience

Let’s set aside the categories of autism and ADHD here. They’re useful, and for many of us hard won, but they're blunt instruments. They don't map cleanly onto the reality of our working day.

What shapes our experience of the workplace is not the category. It’s the traits. They overlap heavily between autism and ADHD, and many of us are AuDHD (both), so I’m breaking this down by trait. If you want a breakdown of traits by category, I covered that in this article on self-identification.

Attention and focus

Our attention isn’t weaker. It’s regulated differently. It runs on interest, not importance. Hand us something that grips us and we lock in for hours and out-produce everyone. Hand us a boring, low-stakes task and starting it can feel physically impossible, no matter how much we want to get it done.

We also get stuck in focus, not just knocked out of it, so being interrupted mid-flow is its own kind of pain. For us, this is not just a case of getting back to the task we were on. We first need to recover from the overwhelm of the interruption, which takes its own time, and our productivity might still not be what it was pre-interruption.

Hyperactivity and impulsivity

For many of us, the behavior that reads as “disruptive” or “annoying” to everyone else is just how our nervous system stays regulated enough to be present: fidgeting, a need to move, a real struggle to sit still through a ninety-minute meeting that could have been a simple email.

It also shows up as impulsivity: blurting the idea, interrupting, making the call fast. We do this because we know that if we don’t get it out we will lose our train of thought, and that creates its own anxiety.

In the wrong setting that reads as “disruptive.” In the right one it’s energy, momentum, decisiveness, and a bias toward action while everyone else is still scheduling the pre-meeting.

This is the kind of “get shit done” mentality that can thrive when it’s cultivated in the right way, rather than rejected as a disruption.

Sensory processing

For most, the typical office environment might just be another day at work. For many neurodivergent people it’s a special version of hell: fluorescent lights, a loud open-plan room, strong smells, an uncomfortable chair.

This is not a preference. Every bit of energy spent filtering an overwhelming environment is energy not spent on the job. The default office environment that works fine for neurotypical people is quietly draining us all day.

Executive function

The things that turn intention into action are a challenge for us: task initiation, working memory, prioritization, time management. But please stop asking us if we have tried your planning system. The neurotypical ones don’t work for us.

A vague instruction like “just get this sorted when you can” can stall us for a week. With time blindness, a task with no urgency has no timeline at all.

Deep focus and special interests

Give us a subject we care about and we go deep in a way most people don’t. Total immersion, fast mastery, and an appetite for the kind of detail others find tedious.

This is where the pattern recognition, the systematic thinking, and the knack for spotting the problem nobody else noticed all come from.

The problem is that we are often not placed into roles or on tasks that engage us. This not only results in an inability to get the thing done, or burnout from “just pushing through,” it’s a huge waste of potential that could be leveraged by aligning the work we’re given with who we are.

Communication and social interaction

The fact that success at work is so often based on indirectness, or as it’s commonly known, “networking skills,” makes it very difficult for neurodivergent people to progress in the workplace.

A lot of us are very direct. We say what we think is correct rather than what you want to hear. We miss or ignore the unwritten rules, the small talk, the political subtext of a meeting. That directness is often exactly what a team needs. It’s also often read as blunt, cold, or difficult by people expecting neurotypical behavior.

The constant chats by the coffee machine might be a nice break from the actual work for some people. For us it’s a cognitive drain, on top of the masking required to act "normal" while you talk about your new supplement stack, when all we want is a coffee in silence to replace the dopamine that listening to your small talk is depleting.

I have fond memories of eating lunch alone, well away from the office, avoiding the company of my colleagues at all costs to get some respite from the constant coffee chats and interruptions.

In one role I would literally run from the office over to the building with the gym and work out on my own every day for an hour, headphones in, so no one made the mistake of interrupting my alone time.

That wasn’t me being antisocial. At the time I was undiagnosed and didn’t realize why I was doing it. It was the only way to claw back enough energy to do the actual work, and in the end it still wasn’t enough.

Emotional regulation

Many of us feel things at high volume, including criticism. Rejection can land hard, sometimes out of proportion to what was intended. That same intensity is also where the passion, drive, and loyalty come from. It’s not a flaw to be trained out. It can be a strength that just needs the right environment.

Predictability and change

Some of us need routine and clear expectations to function. Some of us are wired for novelty and go flat doing the same thing forever. Some of us need a balance of both. A last-minute change dumped with no warning, or a role with no clarity at all, is where we come unstuck. Not because we can’t handle work. Because the environment gives us nothing to hold onto.

Businesses require change and adaptability. But most of the overwhelm we feel is about how the change gets delivered, not the change itself. That part is fixable.

Masking

Most of us are being forced to perform. Hiding the stimming, forcing the eye contact, scripting conversations in advance, pretending the lights are fine. It is the single most damaging thing we can be forced to do. The cause of it is having to exist in the wrong environment, and not being given the accommodations we need to perform and thrive at work.

The outcome of masking is catastrophic. It is a major driver of neurodivergent burnout, and it has been identified as a risk marker for suicidality in autistic adults (1).

When you accommodate neurodivergent people in the workplace, you’re not only giving us a chance at earning an income and making your business more competitive.

You could be literally saving lives.

The Benefits of Accommodating Neurodivergent People

The benefits for business

Diversity of thinking

When you exclude neurodivergent minds, you lose the unique thinker in the room.

Neurodivergent people often have what researchers call a spiky profile, meaning we have both real support needs and real strengths (2). Meet the support needs and the strengths become available to both the person and the business.

We make less biased decisions

During a 2008 experiment on the framing effect, participants were offered the same choice twice, worded two different ways. Most people flipped their answer depending on the wording. The autistic participants flipped far less. They saw through to the actual numbers (3).

It was replicated in 2016. This time the researchers checked whether it was really down to difficulty reading emotions rather than autism itself. It wasn’t (4).

We are less likely to fall for the sunk cost fallacy

That’s the thing where you keep pouring money into a failing project because of what you’ve already spent. Autistic people do it less (5).

We are less likely to fall for the decoy effect

You’re choosing between two options, someone adds a third worse one, and suddenly your preference between the original two flips. That’s not rational. It happens to almost everyone. It happens to us less (6).

We see the details other people filter out

When researchers pooled the studies on visual and spatial tasks, autistic people came out ahead on finding a shape hidden inside a busy pattern, and on rebuilding a design from its component parts (7).

We may score higher on divergent thinking

The research here is mixed, and it depends on how ADHD shows up. A systematic review found that divergent thinking, generating lots of different ideas from a single starting point, tends to be stronger in people with ADHD traits, but the effect is less clear in those with a more impairing diagnosis (8).

A systematic review of ADHD at work catalogs the same strengths employers keep rediscovering: creativity, hyperfocus, problem-solving, and resilience (9).

So why do we think differently?

There are probably explanations for this we haven’t found yet. One has decent research behind it: monotropism.

We all have a limited amount of attention. A monotropic mind pours most of it into a few channels, which makes our focus deep but narrow. A polytropic mind spreads the same amount across many channels at once, which makes it wider, shallower, and easier to shift (10).

A peer-reviewed study of 492 adults split them into four groups: autistic, ADHD, AuDHD, and neurotypical. Every neurodivergent group reported more intense focus than the neurotypical group. The AuDHD group reported the most (11).

A separate study, not yet peer-reviewed, measured monotropism directly in 1,110 people and found the same. Autistic participants scored higher than non-autistic ones, having ADHD pushed scores higher, and AuDHD people scored highest of all (12).

If you have ADHD and you’re thinking “hang on, I switch between things constantly”

Same here. But this is about how many things hold your attention at once, not how many you’ve been into over the years. The study of 492 found that the people reporting the most intense focus were also the people reporting the most distraction. The researchers concluded these are two expressions of the same way of regulating attention (11).

That same study also found something worth sitting with. Intense focus was linked to worse quality of life, more anxiety, and more rumination. But when people experienced their focus as productive and enjoyable, that partly offset the negative link.

The same trait can result in opposite outcomes, and it depends on whether your environment lets you use it or punishes you for it.

You need both profiles in the room.

Someone has to hold six projects at once. Someone has to go all the way down into the one that requires depth.

AI is coming for routine work fast, and employers expect that to accelerate (13). What’s left is the work that needs judgment, depth, and original thinking.

That’s exactly what you’ve been screening out. And what your current work environments can’t sustain.

Neurodivergent accommodation case studies

The evidence is not just theoretical.

Companies that reformed their hiring and support to bring in neurodivergent talent, including SAP, Hewlett Packard Enterprise, and Microsoft, report gains in productivity, quality, innovation, and engagement (14).

Hewlett Packard Enterprise saw teams that integrated neurodivergent testers run around 30 percent more productive (14).

That is HPE’s own reported figures, not peer-reviewed studies, but the direction is hard to ignore.

Talent is available

Most of your competitors are still filtering neurodivergent people out at the interview, or even earlier with AI resume filtering, mistaking a spiky profile for a weak one.

That means neurodivergent talent is available and largely ignored. If you’re one of the few who builds a place where neurodivergent people can get hired and do their best work, you get access to a skill set most of your competitors are actively turning away.

Inclusion becomes not only the right thing to do, but a competitive edge.

The benefits for neurodivergent people and society

The benefits of accommodations for neurodivergent people and society as a whole are better explained by breaking down exactly what happens when we are not accommodated, which is currently the default state of employment for us.

The employment statistics

Only about three in ten working-age autistic adults are in employment. Compare that to roughly five in ten of all disabled people and eight in ten non-disabled people (15).

Adults with ADHD are also markedly more likely to be unemployed than their peers, and more likely to be underemployed and struggling to hold a role even when they are in one (16).

I myself am part of these statistics. Early in my career I worked at IBM and Goldman Sachs. I have not held a conventional job in three years. That time has gone into an ADHD coaching certification and building tools for late-identified neurodivergent adults.

We are not lazy people who don’t want to work, as some might say. Most of us want to contribute to society more than anything.

Excluding us from the workplace is not only a devastating outcome for our lives. It costs society as a whole through the massive gap in productivity that could be filled by smart employers who can leverage the divergent skills we bring (17).

The burnout cascade

As mentioned before, the lack of an accommodating workplace environment results in a brutal process that I will refer to as the burnout cascade:

Stage one: masking

Because the environment won’t flex, we have to flex instead. We spend the workday suppressing who we are to pass as neurotypical. Camouflaging like this is common, it’s most intense at work, and it comes at a measurable cost to mental health (18).

Stage two: burnout

We can’t mask forever. The research is clearest on autistic burnout, but burnout hits ADHD people too. One workplace study of 171 employees found that those with ADHD reported significantly higher job burnout than colleagues without it (19).

Researchers define autistic burnout as chronic exhaustion, loss of skills, and a shrinking tolerance for any kind of stimulus. This is not a bad week. It can last months or years, and it can strip away skills for long periods. It is tied directly to the mismatch between what’s expected of us and what we’re supported to do (20).

Stage three: mental health problems

This stage coincides with the previous one. Sustained masking and chronic stress are linked with anxiety and depression (18). The picture on suicidality is stark: roughly a third of autistic adults without an intellectual disability report having experienced suicidal thoughts (21), compared with around one in ten people in the general population (22).

Stage four: the inability to work

This has been gradually building through stages two and three, and eventually comes to a head. Exhausted, unwell, and unsupported, people drop out. They lose the job, or leave. They can’t start the next one, or they can’t sustain anything long enough to build a career. Not because we lack ability. Because the cascade was allowed to run its course.

The bitter truth is that every stage of this was preventable, and it starts with accommodating us in the workplace.

Neurodivergent people are not getting diagnosed to claim freebies. We’re beginning to understand ourselves for the first time in our lives.

We’re not lazy. We desperately want to contribute like everyone else.

The real problem is clear, and it is supported by the research in the references below.

We are not being included in a workplace that was designed to only support the majority neurotype.

This moral failure doesn’t only harm us. Companies are leaving skills on the table that they can’t afford to lose in the future.

For a neurodivergent person, accommodations are not perks. They are the conditions that let us function at the same level as everyone else.

So please, don’t listen to the noise of ignorant, ableist propaganda, and help us, so that we can help you 🙏

It’s not just the right thing to do. It’s the smart thing to do.

Have a great week,

Rich

What is your experience of this? I want to hear your thoughts. Please comment with your feedback.

And subscribe below to access The Neurodivergent Workplace Accommodations Guide.

References

1. Cassidy, S., et al. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, 42.

2. Doyle, N. (2020). Neurodiversity at work: a biopsychosocial model and the impact on working adults. British Medical Bulletin, 135(1), 108–125.

3. De Martino, B., et al. (2008). Explaining enhanced logical consistency during decision making in autism. Journal of Neuroscience, 28(42), 10746–10750.

4. Shah, P., et al. (2016). Emotional decision-making in autism spectrum disorder: the roles of interoception and alexithymia. Molecular Autism, 7, 43.

5. Fujino, J., et al. (2019). Sunk cost effect in individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(1), 1–10.

6. Farmer, G. D., et al. (2017). People with autism spectrum conditions make more consistent decisions. Psychological Science, 28(8), 1067–1076.

7. Muth, A., et al. (2014). Visuo-spatial performance in autism: a meta-analysis. Journal of Autism and Developmental Disorders, 44(12), 3245–3263.

8. Hoogman, M., et al. (2020). Creativity and ADHD: a review of behavioral studies, the effect of psychostimulants and neural underpinnings. Neuroscience and Biobehavioral Reviews, 119, 66–85.

9. Hotte-Meunier, A., et al. (2024). Strengths and challenges to embrace attention-deficit/hyperactivity disorder in employment: a systematic review. Neurodiversity, 2.

10. Murray, D., et al. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139–156.

11. Dwyer, P., et al. (2024). A trans-diagnostic investigation of attention, hyper-focus, and monotropism in autism, attention dysregulation hyperactivity development, and the general population. Neurodiversity, 2.

12. Garau, V., et al. (2023). Development and validation of a novel self-report measure of monotropism in autistic and non-autistic people: the Monotropism Questionnaire. OSF Preprints.

13. World Economic Forum. (2025). The Future of Jobs Report 2025.

14. Austin, R. D., and Pisano, G. P. (2017). Neurodiversity as a competitive advantage. Harvard Business Review, 95(3), 96–103.

15. Buckland, R. (2024). The Buckland Review of Autism Employment: report and recommendations. Department for Work and Pensions.

16. Küpper, T., et al. (2012). The negative impact of attention-deficit/hyperactivity disorder on occupational health in adults and adolescents. International Archives of Occupational and Environmental Health, 85(8), 837–847.

17. Pro Bono Economics. (2023). Opening opportunities: improving employment prospects for autistic people. Report for Autistica.

18. Cage, E., and Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911.

19. Turjeman-Levi, Y., et al. (2024). Executive function deficits mediate the relationship between employees’ ADHD and job burnout. AIMS Public Health, 11(1), 294–314.

20. Raymaker, D. M., et al. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: defining autistic burnout. Autism in Adulthood, 2(2), 132–143.

21. Newell, V., et al. (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Molecular Autism, 14(1), 12.

22. Nock, M. K., et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192(2), 98–105.

Because I’m pissed off this week, I decided to just write about all of the things that piss me off as a neurodivergent person.

This is either all really negative or just short on fake positivity. I’ll let you decide.

Tell us we’re “taking advantage of being autistic” for needing work accommodations

Around 70% of us are out of work because of opinions like that.

Help us to contribute, and you won’t have to complain about all of the public funds we use when we’re out of work.

We’ll all be more productive as a society.

Ask us why we “keep changing jobs”

There are no jobs that accommodate us, and many of us were only made aware of our workplace needs in our 30s, 40s, or even later.

Tell us we “just need the right job”

We’ve had the right job several times. It’s just that nobody cared enough to create an environment we were able to exist in.

Tell us we “never listen to you”

No, we don’t ever really fully listen to anyone.

We’ve got a thousand of our own voices in our head telling us how badly we did with the stuff we actually managed to listen to.

Plus all the project ideas we’ll have forgotten by the next time we see you. Which brings me to my next point.

Ask us how our project is going

What project might that be? The one I told you about and forgot about the same day, or the thousand I started and forgot about since we last met?

Ask us why we haven’t “settled down” yet

“Settling down” is not the universal concept that you seem to believe it is. It’s different for everyone.

We don’t all need to be married with kids by the time we’re 30. For many of us, that timeline was never realistic, and for some it was never the goal.

Some of us may never have kids, and that’s also fine.

When you haven’t built a society where we can hold down a job, why would you expect us all to afford kids?

Ask us why we “can’t stay in one place”

No, because the environments society created are either horrendously boring or physically painful for us to exist in.

Tell us to “smile for the camera”

Some of us haven’t developed the ability to fake emotions, and we don’t want to. Make me laugh, or be quiet and take a picture of my emotionless expression.

Tell us we’re “fussy”

No, we just have standards. Some of those might be very specific, but it is better than having none.

Tell us we’re “obsessed” with something

Yes, maybe that’s something to encourage, rather than put us down for.

Tell us we’re “too direct”

You’re too fake.

Tell us to “just try harder”

The output you’re judging is the result of effort you have no access to.

Ask us “have you tried a planner?”

You mean the ones designed for neurotypical people? Sure, that worked great.

Tell us to “be more organized”

You’re seeing the result of our effort to organize and mistaking it for the starting point.

Tell us to “make eye contact”

We’re having to use enough mental effort just to listen to you say that, never mind process what’s going on with your face.

Tell us to “sit still”

Do you want us to sit still, or be regulated enough to listen to even a fraction of what you’re saying? Which would you prefer, because you can’t have both.

Tell us we’re “too intense”

Our intensity makes us care about you at a depth most people never bother to reach. This is the price of our loyalty and passion.

Ask us why we “can’t just push through” like everyone else

Because pushing through is what produced the lack of empathy and emotional intelligence that caused you to say that.

I would prefer to adapt my life based on a deep understanding of myself, rather than “just push through” and act out on others as a result.

And by the way, not everyone is “just pushing through.” Masking to meet that expectation is linked to a much higher risk of suicide.

Tell us that you don’t believe in autism and ADHD

Great, thanks. We still exist. Just like the Earth is still round, even though not everyone believes it.

Tell us “everyone’s a little bit autistic”

So the thing that reshaped our entire understanding of ourselves is just the standard human experience, and we should stop making a fuss about it? Nice.

Tell us “everyone forgets their keys sometimes”

Sure. And everyone gets sad sometimes, but that’s not depression. You’re taking one symptom and using it to shrink a whole neurotype down to something you’ve experienced.

Tell us it’s “over-diagnosed these days”

Whole neurological groups of people are getting help for the first time in their lives. That’s not a trend.

And if it was over-diagnosed, why are so many of us still being late-diagnosed? The incoherence in your reasoning is stark.

It sounds more like propaganda created by those who care more about money than people. You’re either one of those people or naive enough to fall for them.

Tell us we “have a superpower”

Sometimes, sure. At other times it’s just a disability, and calling it a superpower is a bit patronizing.

What did I miss? Add yours in the comments.

Hopefully none of us have to hear any of the above this week 🤞

Have a great one,

Rich

This article is an open question to the neurodivergent community.

Over the last month I’ve explored the concept of self-identification a lot, including writing an article on how to self-identify ADHD, autistic, and AuDHD.

While I was writing it, I felt a nagging sense that a self-identification tool could be far better than what I was building. And that pointing people toward diagnostic criteria is not filling the gaps left by the system that created those criteria in the first place.

I believe that the current formal system we have for identification is pretty awful:

• It treats a spectrum of traits as if it were a group of neat categories

• It focuses only on “deficits”, and treats us as if we are the problem. We’re not.

• It often doesn’t give people who are AuDHD the full picture

• It misses whole populations of people, because it was designed around white men

• Like most aspects of society, it’s designed around what makes money for the privileged few, rather than what actually helps marginalized groups of people

• That leaves most people without access. They either can’t afford a diagnosis, or they live somewhere one isn’t available.

I also believe that the concept of neurodivergent self-identification being valid should become mainstream, so that:

• People who can’t access diagnosis can still access their neurodivergent identity

• The ignorance of the folks against self-identification can start to disappear (hopefully 🙄)

I’m in a position to put significant time into working on solutions for this. But before I commit, I want to know whether others in the neurodivergent community see it as a big problem too, and want new solutions.

That’s what this article is about. I’m going to break down my position on the current state of neurodivergent identification, why I believe we need more accessible identification tools, why those tools need to be built by us, and how I think those tools should look.

But most importantly, I want your opinion.

Do you think we need better self-identification tools?

How would you want those to look?

What is your experience of this?

Please comment with your thoughts, and please restack/share this so I can hear from others 🙏❤️

The Broken Categorical System

The medical system’s long practice of treating the neurodivergent spectrum as separate categories of “disorders” is not just offensive and incorrect in its terminology. It is dysfunctional.

The categories are administrative conveniences, not a map of how people are actually wired. AuDHD is the clearest proof, because for thirty years the manual refused to admit it existed.

The autism/ADHD overlap

It was only in 2013 that the medical system allowed co-occurring diagnoses of autism and ADHD (1). The overlap that the old rule ignored is huge. Clinical reviews report ADHD in 50 to 70% of autistic people (1). Autism and ADHD share genetic and trait-level architecture, which is why researchers increasingly describe neurodivergence dimensionally rather than as tidy boxes (2).

Separate categories also mean separate assessments and queues. Because the two are assessed through different pathways, an AuDHD person has to seek two assessments, wait twice, and self-assemble the result. My own three-year gap between ADHD diagnosis and AuDHD identification is not an anomaly. It is what the architecture produces.

The missed demographics

The system also misses whole demographics of the population that its categories were not designed to fit. Diagnostic overshadowing, where one recognized label stops clinicians from looking for the rest, disproportionately hits women, gender-diverse people, and adults who mask (3). AuDHD people are the most exposed to this because they present two overlapping profiles for a single-label system to collapse into one.

The Access Gap

The lack of access to the formal neurodivergent identification system is an inevitable outcome of the way that diagnosis is structured. When it requires thousands of dollars and hours of specialist clinician time, some people will always be left out.

The US access gap

The access gap is not only a problem in low- and middle-income countries. It is a systemic injustice that is also felt in the countries where the research comes from. In the US there is no free route to a formal diagnosis. Medicaid covers some assessment, but it varies by state and many providers will not take it.

About 26 to 27 million Americans, roughly 8% of the population, are uninsured (4). Nearly one in four working-age adults are underinsured (5): they have coverage but still face out-of-pocket costs high enough that care becomes unaffordable.

The UK access gap

In the UK the price to the individual is only part of the problem. The bigger issue is that diagnostic costs are completely unsustainable for the National Health Service (NHS).

The average wait for an autism assessment is now over 16 months (6). As of December 2025, 254,108 people in England were waiting for an autism assessment, and 90% had already waited longer than the 13-week NICE guideline (7).

On the ADHD side, 177,404 people were waiting, with just 21,011 assessments completed in a year, and some regional backlogs projected to take eight years to clear (8).

In the UK you can skip the queue by going private, which reduces the wait to months rather than years. But with an escalating cost-of-living crisis, the number of people who can afford to pay thousands to access their identity is dwindling.

The global access gap

Globally, the situation is even more dire. In epidemiological studies, 86.5% of identified autism cases come from North America, Europe, and Japan, even though only about 10% of the world’s children live there (9).

The vast majority of autistic people live in low- and middle-income countries, where diagnostic services barely exist and one documented barrier is the high cost of the proprietary tools that diagnosis depends on (9). For most of the planet, a formal diagnosis is not delayed. It is simply unavailable.

Why No One Else Is Building This

Because there is no money in it. And that is the whole problem.

There is serious money in diagnosis. Billions are spent on it globally every year. Diagnosis is a product, and business is booming.

Screening tools get funding because they guide people toward diagnosis. They are built to flag one category at a time, because that is how the medical system decided to organize help for neurodivergent people.

Public health systems were never built for identity. They ration diagnosis to decide who gets medication and treatment. Understanding yourself is not on their list. Neither is making sure everyone can access the help they need.

This is why useful identification tools need to come from the neurodivergent community.

We’re the ones who understand why people need them, and we’re the only ones who care enough to build them without profit as the goal.

How a Self-Identification Tool Should Look

Not a diagnosis tool

It should look very different from a diagnostic tool. Diagnosis is managed by the medical system, and it is designed to determine who requires help from that system. That is a different job, and a self-identification tool does not replace it. It solves a different problem: giving people insights into their neurodivergent traits, so that they can better understand and express their identity without feeling lost or left out by the system.

People who can’t access diagnosis.

People who are on a ridiculous waiting list for years.

People who are unsure.

The outcome is not medical access. It is identity access that enables people to understand themselves and their needs. It should answer questions like: Who am I? Why have some parts of my life felt so difficult? Why have others come easily? What accommodations might I need from the people around me? How might I adapt my environment to fit my needs?

Not an advanced screening test

A screening test guides you toward a predefined medical category. A self-identification tool should give people information about where their traits sit on the neurodivergent spectrum, rather than pushing them toward specific categories.

The outcome should be useful information about who you are and what you need. Not a suggestion for a closer look.

Cover the full spectrum

It should cover the full neurodivergent spectrum of overlapping traits. That means traits from both autism and ADHD, because they overlap so heavily that they need to be understood as one wiring, not boxed off separately.

Cover strengths, not just challenges

The medical system focuses solely on traits that it considers to be a deficit. For ADHD it even puts the word “deficit” in the name.

Common sense tells us that deficits do not define us. Neurodivergence is a complex and brilliant spectrum of traits that can bring both ease and difficulty, largely depending on the environments and systems we find ourselves in.

There are significant strengths that come with a neurodivergent profile, and those should be recognized, explored, and understood at the point of identification, alongside the traits that bring us difficulty in certain environments.

This would give us a clear picture of not only where we need help and accommodation, but also the aspects of our identity that we can lean into and leverage.

Cover the whole population

It should not miss anyone.

Diagnosis has a long history of missing entire groups, women most obviously. Any research or input that shapes a tool like this has to include everyone. Different genders. Minority groups. All of us.

No gatekeepers

Access should not be based on how much money you have, what country you live in, or anything else.

Everyone should be able to access it.

We have no choice but to go through the medical system for medication, but I don’t think we should rely on it for neurodivergent identification. It is clearly not a functional way to give people their identity.

It makes sense to build a separate process. One where everyone can access it, and everyone gets a clear picture of their full neurodivergent wiring in one go. No barriers.

What Do You Think?

As mentioned, I’m considering focusing on this problem, and I need your input. If you have any thoughts, ideas, suggestions, or just insight about your own experience around identification, please comment with your feedback.

And if you believe that this problem is worth focusing on, then please restack and share with your thoughts, so I can get as much feedback as possible.

I appreciate your time 🙏 ❤️

Have a great week,

Rich

References

1. Antshel, K. M. et al. (2016). An update on the comorbidity of ADHD and ASD: a focus on clinical management. Expert Review of Neurotherapeutics, 16(3), 279-293.

2. Petruzzelli, M. G. et al. (2025). An update on the comorbidity of ADHD and ASD and its clinical management. Expert Review of Neurotherapeutics, 26(1), 75-89.

3. Dolfi, A. et al. (2025). Diagnostic challenges of autism spectrum disorder in women without intellectual or language impairments: a narrative review. Journal of Medicine and Life, 18(8), 710-720.

4. U.S. Census Bureau (2025). Health Insurance Coverage in the United States: 2024. Current Population Reports, P60-288.

5. Collins, S. R. and Gupta, A. (2024). The State of Health Insurance Coverage in the U.S.: Findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey. Commonwealth Fund.

6. National Autistic Society (2025). Autism assessment waiting times, November 2025.

7. National Autistic Society (2026). Over 254,000 face waits for autism assessment.

8. BBC News (2024). Investigation into ADHD assessment waiting lists (177,404 people waiting; 21,011 assessments completed in 2023).

9. Durkin, M. S. et al. (2015). Autism screening and diagnosis in low resource settings: challenges and opportunities to enhance research and services worldwide. Autism Research, 8(5), 473-476.

I am writing this to you lying flat in bed.

Not because I’m lazy, but because I haven’t been able to sit down, sit up, or walk for more than 5-10 minutes for almost a year due to a chronic injury caused by a physio in Chiang Mai, Thailand, where I was living until last year.

I’m not writing any of this for sympathy, that’s for sure. I actually decided to …

Read more

If you’re neurodivergent, rest is not something you earn at the end of a productive day. It is the thing that lets the day happen at all.

That is not weakness, laziness, or a lack of discipline. It is how your nervous system is built. The same hour, the same meeting, the same supermarket trip costs you more than it costs a neurotypical person. Spend more energy, and you have to rest more. The logic is simple. The guilt we attach to it is the part that doesn’t add up.

We absorb a productivity culture that treats rest as something owed only after enough output. Layer internalized ableism on top, the quiet belief that we should be able to cope like everyone else if we just tried harder, and rest starts to feel like proof of failure. It is not. Your system runs a heavier load.

Resting more is the logical response to that, not a moral weakness.

If only society measured productivity in value of output, rather than quantity of output, everyone would be resting like they were neurodivergent. We would all have well-rested minds that can identify the relevance of an idea or unit of work, and quickly decide if it should be done, or if we would be better off spending that time resting.

This piece is about three things. Why neurodivergent people need more rest. What happens when we keep pushing past the point we should stop. And how to actually rest, which is harder than it sounds when your nervous system refuses to power down.

I have created The Neurodivergent Guide to Rest, which goes into more depth on different techniques for quality rest, including neuroscience-backed techniques, as well as some of the tools that have worked well for me.

Get access to that for free by subscribing below, or open the subscriber chat in the Substack app if you are already in.

Why Neurodivergent People Need More Rest

The cost of masking

Masking is the constant performance of looking fine. Suppressing the fidget. Rehearsing the small talk. Forcing the eye contact. Holding your body still when it wants to move. It runs quietly in the background, and it is expensive.

Camouflaging autistic traits is consistently linked to mental and physical exhaustion, and over time to anxiety, depression and burnout (1, 2, 3). The effort of monitoring and editing yourself in real time does not stop when the conversation ends. It carries on, and it drains us.

Masking is just as real for ADHD, and more common than people assume. In one study of adults with ADHD, more than 91 percent said they camouflaged their traits to fit in, by suppressing the urge to fidget, rehearsing conversations, over-preparing and pretending to follow along. The cost was exhaustion, anxiety and low self-esteem, with some needing days to recover after intense periods of masking (4).

For AuDHD the mask rarely comes all the way off. There are fewer settings where the whole self feels safe to show, so the performance becomes close to permanent. The load is not occasional. It is the baseline. That alone explains a lot of the tiredness that no amount of an early night seems to touch.

The cost of a world that is too loud

Sensory input is energy. For us the world arrives louder, brighter, busier and harder to filter, and processing all of it takes fuel that other people get to keep. If only neurotypical people knew how lucky they were to keep that extra energy, they would probably be more open to accommodating us.

Autistic adults process sensory input differently and often cannot tune out background noise, light and movement the way neurotypical people do. Overload tends to build gradually across a day rather than arrive all at once, and it is followed by real fatigue and a need to recover (5). Left unmanaged, that constant sensory load is one of the drivers of burnout (1).

The ADHD brain also struggles to filter the irrelevant. Every notification, every conversation in the next room, every flickering screen competes for attention that has to be actively pulled back. That filtering is effort, and effort is energy.

For AuDHD, heightened sensory sensitivity and a strong pull toward stimulation live in the same body. The environment is rarely neutral. It is either too much or not enough, and steering between those two states all day is its own quiet, draining job. It feels like never really being able to find an equilibrium in our day. There is rarely an environment that is both calming and stimulating at the same time.

The brain that will not switch off

Even when the body is still, our mind often is not. A brain that runs constantly does not get to rest just because you have sat down.

Excessive, spontaneous mind wandering is now understood as a core feature of ADHD. The brain network that should quieten during downtime does not deactivate the way it should, leaving a constant background hum of self-generated thought. The same mechanism makes it harder to fall asleep, because the mind keeps generating when you most need it to stop (6).

There is a different but equally costly load here. Scripting conversations in advance, replaying them afterward, predicting what comes next, tracking social rules that others absorb without thinking. That is sustained cognitive effort, running under the surface of an ordinary day.

For AuDHD the mind is busy and the body stays alert at the same time. Stillness does not bring quiet by default. Rest has to be built deliberately, because it doesn’t arrive on its own.

Fluctuating energy and the missing warning lights

Our energy does not run in a straight line. It surges and drops, and crucially, we often cannot feel the drop coming. It’s hard and often impossible to keep up with traditional work styles when you can get a week’s worth of work done in one day, and then be incapable of human interaction for days after.

Many autistic people have reduced interoception, the sense that reads the body from the inside. Signals like fatigue arrive late, faintly, or not until they are extreme (7). The warning lights are dim. So we sail past the point a neurotypical person would have stopped, and only notice we are empty when we are already running on fumes.

ADHD hyperfocus does something similar from the other direction. When a task grips, hunger, thirst and tiredness all drop below the threshold of attention. We override the signals without meaning to, then crash once the focus breaks.

For AuDHD the warning lights are faint and the wiring pushes you to keep going anyway. The result is a crash that seems to come from nowhere, when really the signs were there the whole time. We just could not feel them.

Sleep that does not pay us back

Rest is supposed to be banked overnight. For many of us, the night does not reliably repay the day.

Sleep problems are far more common in autistic people and persist into adulthood, including trouble falling asleep, staying asleep and getting sleep that actually restores (8).

Adults with ADHD have high rates of insomnia, delayed sleep timing and poor sleep quality (9). The wired but tired feeling at bedtime is a known pattern, not a personal failing.

AuDHD sleep is rarely the clean reset it is meant to be. We often start the next day already in deficit, which means the energy cost of everything above lands on a tank that was never fully refilled.

What Happens When We Don’t Get Enough Rest

Ignore the cost long enough and the bill comes due. For us it does not look like ordinary tiredness. It looks like the floor falling out.

Autistic burnout is its own distinct state. Autistic adults describe it as chronic exhaustion, a loss of skills you previously had, and a reduced tolerance to stimulus, affecting every area of life (1). It is not laziness and it is not depression, though it is often mistaken for both. Recovery is slow, and the things that caused it tend to still be there waiting when you surface.

ADHD burnout often follows a cycle. Overcommit, run on adrenaline and last-minute pressure, crash, then carry the shame of not being able to keep it up. Repeat. The crash is the body forcing the rest you would not give it willingly.

For AuDHD the picture is heavier. Research following young people into early adulthood found that those with co-occurring autism and ADHD carried a particularly heavy load across health, daily functioning and support, with the authors describing it plainly as a heavy burden for health (10). Fewer recovery windows. A lower floor. More to carry, with less slack to carry it.

If you are going through burnout, then you have even less to apologize for needing rest. The truth is you might need to rest for years. Some will start to gradually rebuild as they take a break from lives of masking. Others will need full rest before rebuilding, and that is absolutely fine.

People will say things like: “Why are you not working at your age?” Or, “How are you going to make money from that?” Ignore them. Recovering from burnout isn’t about making money or any other performance for society. It’s about taking all the rest you need, and gradually changing the environment that caused it.

The Cruelty of the Chronic Pain Overlap

There is one more thing to name, because it stacks on top of everything above. Many of us do not only carry mental and sensory load. We carry physical pain too.

Neurodivergent people are far more likely to be hypermobile. In one study, more than half of autistic and ADHD adults showed raised levels of joint hypermobility, against around a fifth of the general population, and they reported significantly more pain and dysautonomia, such as dizziness on standing (11). The body itself runs differently, and that difference often hurts.

This makes the rest equation harder, not easier. A body in pain needs rest to recover. A body that does not sleep well cannot recover properly. Pain and exhaustion feed each other, and rest is one of the few things that interrupts the loop. When pain is in the picture, resting before the crash, rather than after, becomes the whole game.

How to Actually Rest

Rest is a skill most of us were never taught, partly because the version we were handed was built for a different kind of nervous system.

The most useful thing you can do as a neurodivergent person is to redefine what rest is. Rest is not necessarily doing nothing. It is reducing demand. The neurotypical image of rest, lying still and doing nothing, is often the least restful option for us.

One of my favourite ways of resting right now is drawing mandalas. When I’m drawing I find that I’m able to switch off for such long periods. I’ve been getting into pen art lately, and recently combining that with my interest in spirituality.

A note on spirituality, since this is the first time I’ve mentioned it here. Mystical and transcendent experiences are well-documented across cultures and throughout history. Whatever you think causes them, the experiences themselves are real. But being drawn to spirituality doesn’t require supernatural beliefs. And you don’t need any of that to get something meaningful from drawing mandalas. The practice works on its own terms.

I love the process of drawing mandalas, because you don’t need to have the whole thing planned out in the beginning. You just create some circles and add shapes to them as you go along. It is a form of meditation that has been done for thousands of years, and is often used in therapy. It is also the only form of meditation you can still see once you are finished.

More on that, as well as a comprehensive list of science-backed tools and methods for resting a neurodivergent mind in The Neurodivergent Guide to Rest.

Get access to that for free by subscribing below, or open the subscriber chat in the Substack app if you are already in.

Stop apologizing to yourself and everyone else for needing the thing that keeps you functioning. The guilt was never yours to carry. It belongs to a world that was built for a different kind of neurology and then called you the problem when you struggled inside it.

Taking rest when you need it is not being weak. It is doing the maintenance that everyone else does when they have expended all of their energy.

You expend energy at a faster rate because the conditions you need to function like everyone else are not there. That’s not your fault.

Have a great week, and rest!

Rich

References

1. Raymaker DM, et al. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143.

2. Hull L, et al. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534.

3. Cage E, et al. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911.

4. Mylett M, et al. (2026). “I wish I could just be myself”: Experiences of social camouflaging in adults with ADHD.

5. MacLennan K, et al. (2022). In our own words: The complex sensory experiences of autistic adults. Journal of Autism and Developmental Disorders, 52(7), 3061–3075.

6. Bozhilova NS, et al. (2018). Mind wandering perspective on attention-deficit/hyperactivity disorder. Neuroscience & Biobehavioral Reviews, 92, 464–476.

7. Mul CL, et al. (2018). The feeling of me feeling for you: Interoception, alexithymia and empathy in autism. Journal of Autism and Developmental Disorders, 48(9), 2953–2967.

8. Baker EK, et al. (2015). Sleep patterns in adults with a diagnosis of high-functioning autism spectrum disorder. Sleep, 38(11), 1765–1774.

9. van der Ham M, et al. (2024). Sleep problems in adults with ADHD: Prevalences and their relationship with psychiatric comorbidity. Journal of Attention Disorders.

10. Lebeña A, et al. (2023). Clinical implications of ADHD, ASD, and their co-occurrence in early adulthood: the prospective ABIS-study. BMC Psychiatry, 23, 851.

11. Csecs JLL, et al. (2022). Joint hypermobility links neurodivergence to dysautonomia and pain. Frontiers in Psychiatry, 12, 786916.

If you’ve worked out that you might be ADHD, autistic or AuDHD, the next question is how to explore and validate that for yourself.

That’s what this article is for. I covered why self-identification is valid in a separate article. This one is the method. We’ll start with screening tools and why they’re only a starting point, then walk through how ADHD and autism are diagnosed against the real criteria, in plain language, for both the UK and the US.

If you are one of the many who have traits overlapping from both ADHD and autism, then this can give you an insight into the identification of AuDHD. A neurotype of its own that is not specifically diagnosed, due to a flawed system that prefers rigid categories over the more likely reality: a spectrum of neurodivergent traits.

As the medical system catches up with the research, we will hopefully eventually have more accurate ways of identifying neurodivergent people. For now, this is all we have to work with.

Screening over-identifies on purpose. It flags anyone who might warrant a closer look through a full diagnostic assessment. Diagnosis determines who gets access to resources from the medical system.

Diagnosis would be a great way of identifying who is neurodivergent, if everyone had access to it. Unfortunately, most people do not. This is the main reason why I believe that self-identification should be core to neurodivergent identity recognition.

To be clear, I am not claiming you have to use any of the information in this article for your self-identification to be valid. I am also not claiming that the use of this article is the equivalent of a medical diagnosis. I am writing this as a resource to bring clarity to those who are unsure of their neurodivergent identity, and want to explore it without the barriers of the medical system.

Bear in mind that the diagnostic guidelines exist to decide who gets help from the medical system, and there is currently no ideal way of using them to identify who is actually on the neurodivergent spectrum of traits.

This article walks through the criteria themselves. The full guide goes a step further: it adds a plain-language explanation under every criterion, plus a prompt to weigh each one against your own life. Subscribe for free below to access that straight away.

Screening Tools Are an Indication, Not an Identification

Screening tools are built for high sensitivity, meaning they catch most true cases. This is done at the cost of specificity, meaning they also flag people who do not have the condition they are testing for.

They’re a good starting point if you’re considering a formal diagnosis, and most clinicians will expect you to have taken one before undergoing a formal ADHD or autism assessment. But they are not sufficient as a thorough self-identification tool due to the specificity limitation.

Here is an overview of the most reputable screening tools for ADHD and autism. Even though some of these tools were developed in the UK, and some in the US, they are used as standard internationally. If you believe that you might be AuDHD, then until we have AuDHD-specific screening tools you need to screen for both ADHD and autism.

ADHD screening tools

For ADHD there is one screener worth starting with, and it is the one clinicians recommend.

The ASRS (Adult ADHD Self-Report Scale) was developed with the World Health Organization. The core test is just six questions, takes two minutes, and has high specificity, so a positive result is a strong signal to look closer.

The original v1.1 maps to older criteria, while the updated ASRS-5 aligns with the current DSM-5. Take the ASRS-5 at Embrace Autism.

Autism screening tools

Autism is where it pays to use more than one screener, because a single test rarely catches everyone, especially those who mask.

AQ-10 (Autism Spectrum Quotient, short form). This is the quickest test if you want a fast starting point. Ten questions, two minutes, developed by the Autism Research Centre at Cambridge and recommended by NICE as the referral screen GPs use in the UK. A score of 6 or above suggests a fuller assessment is worth pursuing. Take it at Embrace Autism.

RAADS-R (Ritvo Autism Asperger Diagnostic Scale, Revised). This is the thorough screener for autism. Longer and more detailed, it asks about childhood as well as the present, which matters because autism has to be lifelong. Worth doing if the AQ-10 flagged something or if you want a deeper look. One caveat: its specificity drops in people who also have mental health conditions, so treat a high score as indicative, not conclusive. Take it at Embrace Autism.

CAT-Q (Camouflaging Autistic Traits Questionnaire). This does not screen for autism directly. It measures how much you camouflage/mask, which is exactly why so many late-identified adults get missed by the other tests. If you scored lower than expected on the AQ-10 but still recognise yourself in the autistic experience, this is the test that explains the gap. Take it at Embrace Autism.

A reasonable autism stack is AQ-10 first, then RAADS-R for depth, then CAT-Q if masking might be hiding your traits. Pair that with the ASRS for ADHD, and you have covered both halves of the AuDHD picture as well as screening currently allows.

These are a good starting point before pursuing either formal diagnosis or a deeper self-identification process, using the DSM-5 criteria.

How Autism, ADHD and AuDHD Are Diagnosed

A neurodivergent assessment is not a complex process.

It is a trained person checking your life against a published checklist of criteria, confirming the traits are lifelong, present in more than one setting, causing real impairment, and ruling out other explanations. Which makes it kind of strange that they are gate-kept behind such high fees.

The criteria are public. The structured interviews clinicians use are mostly just organised ways of walking through those same criteria. That is what makes structured self-identification possible: you can work through the same criteria the clinician would, albeit with some caveats, which I cover in the article on why self-identification is valid. (1, 2, 3)

The purpose of this section is to enable people who believe they might be neurodivergent to explore the criteria that clinicians use to guide their decisions in diagnosing ADHD and autism. The two overlap heavily. So if you have been diagnosed with one neurotype, it’s highly recommended that you explore the other in depth to determine if you are actually AuDHD, rather than only autistic or only ADHD.

Below, I’ve listed the criteria themselves, in plain language, so you can see exactly what an assessment measures. The full guide adds an explanation under each criterion, with ways to weigh it against your own experience.

How ADHD is diagnosed

ADHD is diagnosed against the DSM-5 criteria. 18 symptoms, split into two lists: nine for inattention, nine for hyperactivity and impulsivity. As an adult you need five or more from one of the two lists. As a child you need six. The symptoms have to be lifelong, not something that started recently. They have to show up in more than one setting: home, school, work, with friends or relatives, or in other activities. And they have to actually get in the way of your life. (1, 4)

The nine inattention symptoms

• Misses details, makes careless mistakes.

• Struggles to hold attention on tasks.

• Seems not to listen when spoken to directly.

• Doesn’t follow through, leaves things unfinished.

• Struggles to organise tasks and time.

• Avoids tasks that need sustained mental effort.

• Loses things needed to get things done.

• Easily distracted, including by your own thoughts.

• Forgetful in daily life.

The nine hyperactivity and impulsivity symptoms

• Fidgets, taps, squirms.

• Gets up when you’re meant to stay seated.

• Restlessness, which in adults is more an internal feeling than running around.

• Can’t do quiet activities quietly.

• Feels driven by a motor, always on the go.

• Talks too much.

• Blurts answers out before the question’s finished.

• Hates waiting your turn.

• Interrupts and talks over people.

The assessment results in one of three presentations: predominantly inattentive, predominantly hyperactive-impulsive, or combined. (1)

This is the same in the US and the UK. UK assessments run on the same DSM-5 criteria, usually through a structured interview called the DIVA-5, which walks through all 18 symptoms and asks for examples from your childhood and your adult life. If you have been assessed in the UK, this is the checklist you were measured against. (2, 5)

The differences between the US and UK are practical, not in the criteria. In the UK a specialist has to diagnose you, usually after a GP referral or through Right to Choose, and the waiting lists are long, with adult ADHD assessments commonly taking two years or more, and far longer in some areas. In the US the same criteria are applied, but you might be seen by a psychiatrist, a psychologist or some doctors, and the barrier is usually cost rather than waiting lists.

How autism is diagnosed

Autism is diagnosed against the DSM-5 criteria too, across two areas. You need all three traits in the first area, and at least two of the four in the second. It has to be lifelong, even if you masked it for years, and it has to affect your daily life. (1)

Social communication and interaction (all three)

• Differences in back-and-forth interaction, like conversation and sharing interests or feelings.

• Differences in nonverbal communication, like eye contact, gesture and facial expression.

• Differences in building and keeping relationships.

Restricted and repetitive patterns (at least two of four)

• Repetitive movements, speech or use of objects, including stimming.

• Needing sameness and routine, and real distress when it is broken.

• Intense, highly focused interests.

• Sensory differences, being over or under sensitive to things like sound, light or texture.

It is the same model in the US and the UK. UK autism assessments use the same DSM-5 criteria, usually built around two tools: the ADOS-2, where a clinician observes you for around an hour, and the ADI-R, an interview about your developmental history.

The differences are practical, not in the criteria. In the UK an autism diagnosis has to come from a specialist team, usually after a GP referral or through Right to Choose, and the waiting lists are long, often more than a year and in some areas three years or more.

In the US the same criteria are applied, usually by a psychologist or a specialist clinic, but adult autism assessments are frequently not covered by insurance and can cost at least a few thousand dollars, which is the main barrier there.

How AuDHD is diagnosed

AuDHD is not a formal diagnosis.

There is no AuDHD code in either of the diagnostic manuals clinicians work from: the DSM-5, the American manual, or the ICD-11, the World Health Organization’s manual that the NHS files diagnoses under. It is the community term for someone who meets the full criteria for autism and the full criteria for ADHD. So for now, recognising AuDHD is just running both assessments above and finding both thresholds met. That holds in the US and the UK alike. (6, 7)

Until 2013 you could not be diagnosed with both. The old DSM-IV had a rule that an autism diagnosis ruled out ADHD. DSM-5 removed it, which is why dual recognition is recent and why so many adults were only ever given half their picture. Even now, many are assessed for one and never screened for the other, so they still walk away with only half the answer.

Co-occurrence is high, and it runs both ways. Estimates vary widely, but somewhere between 50% and 70% of autistic people also meet the criteria for ADHD, and roughly 20% to 50% of people with ADHD also meet the criteria for autism, with even more showing significant autistic traits. (6, 7)

I had a three-year gap between my ADHD diagnosis and the realisation that I am AuDHD. Rather than the medical community accounting for the huge overlap between autism and ADHD, and actually considering that as part of the diagnostic process, we are left to work that out on our own.

One important consideration for the way that AuDHD is currently identified formally is that the criteria describe two trait sets, but the lived experience is described by people with AuDHD as feeling more like the friction between them rather than autism and ADHD stacked. This makes AuDHD harder to identify, because there is no criteria set for the friction itself. We are left assembling it from two separate checklists that were never built to describe it as one thing. I wrote more about that in this article, which can also be a good resource for exploring AuDHD self-identification. (6)

None of this is as mysterious as the diagnosis price tags suggest. It’s the same checklist process I described at the start, and you can walk through it yourself to understand your own identity if you can’t access a formal assessment or are waiting for one.

So screen first, but treat the result as an indication, not a verdict. Then map yourself against the actual criteria, with a real example from your life for every trait you recognise. Hold yourself to the same standard a clinic would: lifelong evidence, more than one setting, real impact. For AuDHD, check both sets and pay attention to the friction between them, because that’s the part no checklist captures.

If you want to go deeper, subscribe for free below to access the full self-identification guide, which expands every criterion above with a plain-language explanation and a reflective prompt to check it against your own experience.

Have a great week,

Rich

References

1. American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., Text Revision (DSM-5-TR). APA Publishing.

2. National Institute for Health and Care Excellence (NICE). NG87: Attention deficit hyperactivity disorder: diagnosis and management.

3. National Institute for Health and Care Excellence (NICE). CG142: Autism spectrum disorder in adults: diagnosis and management.

4. Doernberg E et al. (2016). Neurodevelopmental Disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11. CNS Spectrums, 21(4), 295–299.

5. Kooij J.J.S. et al. DIVA-5: Diagnostic Interview for ADHD in Adults (DSM-5 version). DIVA Foundation.

6. Hours C et al. (2022). ASD and ADHD Comorbidity: What Are We Talking About? Frontiers in Psychiatry, 13, 837424.

7. Antshel K.M. et al. (2019). Autism Spectrum Disorders and ADHD: Overlapping Phenomenology, Diagnostic Issues, and Treatment Considerations. Current Psychiatry Reports, 21(5), 34.

Neurodivergent self-identification is valid. In my opinion, it has to be.

Roughly four years ago I paid £1,500 for an ADHD diagnosis. I already knew I was ADHD before I joined the meeting. The assessment was a box-checking exercise, and the failed medication titration that followed did nothing to convince me the money was well spent.

A few years later I realized I’m actually AuDHD, something the ADHD assessment never picked up or referred me for. So I was left with even less faith that paying again for an autism diagnosis would tell me anything I didn’t already know.

That is the context I’m writing from. The medical system is expensive and flawed at the same time, and anyone who has been through it might reasonably decide to sidestep the gatekeeping and work things out for themselves. In the UK waiting lists stretch for years. Paying privately costs thousands in both the UK and the US. For a lot of people, neither paying nor waiting is realistic.

None of this means you shouldn’t pursue a formal diagnosis if you’re in a position to. For many people it brings real relief, and it unlocks things self-identification can’t. I’ll come to those. But the question this article answers is simpler and more fundamental: is self-identifying as ADHD, autistic or AuDHD actually valid? I think it is.

To be clear, this article is not advice as to whether anyone should pursue a formal diagnosis or not. All of my content is based on my own lived experience as someone who was late-diagnosed ADHD, and late-identified as AuDHD.

My goal with this article is to explain my opinion on the validity of neurodivergent self-identification, and to encourage others to explore their own identity without feeling like it’s not possible due to the gatekeeping of a failed medical system.

I’m developing the ADHD, Autism, and AuDHD Self-Identification Workbook. In it I break down exactly how each neurotype is diagnosed and how to map yourself against the same criteria a clinician would use.

It bridges the gap between screening quizzes that over-identify and a formal diagnosis most people can’t afford or wait out. The workbook will be free for subscribers. Subscribe below for free to get access once it’s released.

Why Neurodivergent Self-Identification is Valid

The criteria for ADHD and autism were built narrow and biased

Both autism and ADHD were originally described in boys, and the DSM criteria still carry that origin. Women and late-identified adults are diagnosed far later, if at all.

Around one in three autistic women report a previous psychiatric misdiagnosis (often BPD, anxiety or depression), and autistic women report prior psychiatric diagnoses far more often than men, roughly 66% versus 34%, before autism or ADHD is recognized (1).

Misdiagnosis also occurs frequently for those who are predominantly inattentive type ADHD, as the symptoms are not as obvious as those associated with the hyperactive/impulsive type. I’m inattentive ADHD, and I was misdiagnosed with anxiety and “cannabis-induced” depression (whatever that is) at the age of 15.

Masking is measurably higher in autistic women, which is exactly why they slip through assessments built around an observable male phenotype. If the formal system structurally misses entire populations, which it clearly does, self-identification can be more accurate than the gatekeeping that failed us (2, 3).

The criteria decide who gets help, not who you are

A diagnosis is a threshold, and the threshold exists to ration support.

To be diagnosed, your traits have to cause what the manual calls “clinically significant impairment”. The criteria aren’t built to describe a neurotype. They’re built to decide who is “impaired” enough to warrant intervention: medication, accommodations, funding, a place in the queue. They draw a line across what is probably a continuous spectrum, not discrete categories, and call everything past it a disorder (4, 5).

This does not mean everyone is a bit autistic or a bit ADHD. The traits run through the whole population, the way height does, but that doesn’t make everyone tall. Being neurodivergent is sitting far enough along the spectrum that you’re wired differently in ways that shape your whole life. A blurry line is still a line.

So the criteria answer one question. Who does the medical system treat? That is not the same question as who is neurodivergent. You can sit clearly on the spectrum and still fall the wrong side of a line drawn for triage and budgets.

You hold a lifetime of evidence on how your mind actually works. The clinic infers that from the outside in an hour. You have lived it from the inside your whole life. When the question is identity rather than eligibility, that is the more reliable vantage point.

Diagnostic assessments are expensive and waiting lists long

In the UK, a private adult ADHD assessment runs £700 to £1,500, and a private autism assessment £1,000 to £3,000. If you suspect that you’re both, you’re looking at £2,000 to £4,000. For a checklist, applied by a stranger, to your own life.

In the UK there is of course the National Health Service (NHS). NHS England estimates around 2.5 million people in England have ADHD, with over 735,000 open referrals possibly waiting for assessment, and waits running 2 to 8 years in most areas. Autism is the same story: over 254,000 people waiting as of December 2025, around 229,000 of them already past the recommended window, with only a fraction seen in time (6, 7).

The US swaps the queue for the invoice. Adult assessments commonly run into the low thousands of dollars, and insurance rarely covers them. So either you pay, or you go without.

Your neurotype is integral to your identity

Strip away everything your neurotype controls. What’s left of you?

Your neurotype isn’t one feature of your brain. It’s the operating system. It shapes your attention, memory, how emotions hit and how fast you recover, your executive function, how you process sensory input, how you communicate, what motivates you, how you experience time, where your ideas come from, and when you have energy and when you don’t. It determines how you think, feel, and act. If that’s not the foundation of self, I don’t know what is.

So put that next to the last two sections. The criteria miss whole populations. The assessments cost thousands or take years making them inaccessible to the majority of people. Then ask yourself: who has the right to deny you the recognition and accommodation of your own identity, just because a flawed and inaccessible system hasn’t approved it yet?

They didn’t even know AuDHD could exist until 2013

Until 2013, you were not allowed to be both autistic and ADHD. The DSM-IV had an explicit rule that an autism diagnosis excluded ADHD. DSM-5 removed it, and only then could both be recognized in the same person. The result: a whole generation handed half their identity (8, 9).

And even now there is no AuDHD-specific diagnosis. No code in the DSM, none in the ICD. It’s a community term for meeting the full criteria for both, so those of us living it borrow the criteria of two better-defined neurotypes to attempt to understand a third thing entirely. Researchers increasingly argue it isn’t autism plus ADHD stacked, but a distinct presentation needing its own understanding (8).

So for AuDHDers, self-identification isn’t just valid. It’s almost necessary. We’re doing the work the manuals haven’t: recognizing a neurotype from the inside, because nobody wrote the checklist for it.

Why You Might Pursue a Formal Diagnosis (If You Can)

The caveats of self-identification

A high score on a screening quiz is not a diagnosis, and it was never built to be one.

ADHD and autism screening over-identifies. That is by design. Screeners are built to catch nearly everyone who might have the trait, which means they also flag people who do not. That is exactly why self-identification holds stronger when it goes beyond the quiz to the actual diagnostic criteria.

Self-report has blind spots, but formal assessments miss whole demographic populations.

For ADHD, adults tend to underreport how severe their symptoms actually are, because it is just their normal and they have nothing to compare it to (10). For autism, alexithymia and interoception differences mean some people genuinely struggle to read their own internal states, which is the very thing a self-assessment asks you to do (11). This is why clinicians ask for collateral history, a second account from someone who knew you as a child.

But here is where I push back, because the caveat gets overstated. The same research that flags limited insight also concludes that adults are the best informants about their own symptoms (10). Nobody else lives inside your head. A clinician meets you for an hour and works from the outside, through a checklist, against criteria built on a narrow phenotype that misses whole populations and has no well-researched definition for AuDHD at all. And the childhood witness the clinic leans on is itself fragile. It assumes someone was paying attention, is still around, and wasn’t undiagnosed themselves.

So the caveat is not “you cannot know yourself.” It is “do it properly.” Build in what the clinic builds in: lifelong evidence, examples from more than one setting, and a second perspective where you can get one. That is the difference between accurate self-identification and a vibe.

The Benefits of Formal Diagnosis

A formal diagnosis is not more true than knowing yourself. But it unlocks specific things that self-identification can’t.

If you want to try medication, a formal diagnosis is the only way to get to it.

ADHD medication is prescription-only and tightly controlled globally, so there is no route to it without a clinical diagnosis and a prescriber. If medication is something you want to try, the formal pathway is the only door. Self-identification does not open it.

On paper you don’t need a diagnosis to be protected at work. In practice you will almost always be asked for one.

In the UK, the Equality Act 2010 protects you based on how your condition affects your daily functioning rather than on the label itself, so a diagnosis is technically not required. In practice, though, a formal diagnosis is strong evidence that the impact is real, and tribunals and employers weight it heavily (12).

In the US it is similar: the Americans with Disabilities Act covers autism and ADHD based on functional impact, but employers will almost always ask for documentation from a licensed provider before granting accommodations (13). Self-identification rarely satisfies that.

In the UK there is also funding linked to the formal route. Disabled Students' Allowance generally needs evidence of diagnosis. Access to Work doesn't strictly require one, since it's assessed on how your condition affects your work, though a diagnosis can still strengthen a claim.

Closure won’t get you medication or accommodations, but for a lot of people it is the reason that matters most.

For some, having their neurodivergent identity confirmed by a professional is what finally quiets the doubt, especially after a lifetime of being told it was anxiety, laziness, or being called “weird”. That is a legitimate reason, and it’s personal. Only you can decide whether you need it.

So it’s not self-identification versus formal diagnosis. They do different jobs. Self-identification gives you understanding and a framework for your own life, now, for free. Formal diagnosis gives you medication, legally enforceable accommodations, and funding, if you can afford the cost or survive the wait via the NHS.

To summarize: neurodivergent diagnostic criteria were built on a narrow profile that misses women, late-identified adults and anyone who masks. The assessments cost thousands or take years to access, sometimes both. Your neurotype shapes how you think, feel and act, which makes it about as core to your identity as anything could be.

And for AuDHD there isn’t even a neurotype-specific formal diagnosis to gatekeep in the first place. Just a recognition that we are allowed to exist since 2013.

So no, you do not need a clinician’s signature to know who you are. Self-identification, done honestly and rigorously, is valid.

A formal diagnosis still has its place. If you want medication, legally backed accommodations, or simply the closure of having it confirmed by a clinician, the formal route is worth pursuing if you can access it.

But in my opinion, it is the knowing that matters the most, and no one gets to tell you how you should find out.

Have a great week,

Rich

Get the ADHD, Autism, and AuDHD Self-Identification Workbook

In the workbook I break down exactly how each neurotype is diagnosed and how to map yourself against the same criteria a clinician would use.

It bridges the gap between screening quizzes that over-identify and a formal diagnosis most people can’t afford or wait out. The workbook will be free for subscribers. Subscribe below for free to get access once it’s released.

References

1. Kentrou V et al. (2024). Perceived misdiagnosis of psychiatric conditions in autistic adults. eClinicalMedicine, 71, 102586.

2. McDonald TAM (2020). Autism identity and the ‘lost generation’: structural validation of the Autism Spectrum Identity Scale and comparison of diagnosed and self-diagnosed adults. Autism in Adulthood.

3. Minutoli R et al. (2025). Female gender and autism: underdiagnosis and misdiagnosis, clinical and scientific urgency. Frontiers in Psychiatry.

4. Haslam N et al. (2006). The latent structure of attention-deficit/hyperactivity disorder: a taxometric analysis. Australian and New Zealand Journal of Psychiatry, 40(8), 639–647.

5. Constantino JN, Todd RD (2003). Autistic traits in the general population: a twin study. Archives of General Psychiatry, 60(5), 524–530.

6. NHS England Digital (2026). ADHD Management Information, February 2026.

7. NHS England Digital (2025). Autism waiting time statistics (quarterly).

8. Watanabe D et al. (2023). Distinct frontoparietal brain dynamics underlying the co-occurrence of autism and ADHD. eNeuro, 10(7), ENEURO.0146-23.2023.

9. American Psychiatric Association (2013). Highlights of Changes from DSM-IV-TR to DSM-5.

10. Kooij JJS et al. (2008). Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders.

11. Berthoz S et al. (2005). The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder. European Psychiatry, 20(3), 291–298.

12. Equality Act 2010 (UK). Protection turns on substantial, long-term functional impact; diagnosis is evidence, not a precondition. See Stedman v Haven Leisure Ltd [2025] EAT 82.

13. Americans with Disabilities Act (ADA), incl. ADAAA 2008 (US). See CHADD, Laws and Legal Protections.

You finally get an empty evening. No plans, no demands, nothing to chase. Part of you has wanted exactly this all week. The quiet. Nobody needing anything from you.

And within an hour, another part of you is restless, bored, reaching for your phone, vaguely furious that nothing is happening.

You needed the stillness. You can’t stand the stillness.

That’s AuDHD. Not autism with ADHD. The friction between them.

“AuDHD is autism with ADHD” is the most common misconception about it. AuDHD is a neurotype of its own, and its inner world is better described as the friction between ADHD and autism than the sum of the two.

That friction is felt as a push/pull in two directions at once. The autistic side wants predictability, routine, low sensory input, depth, time to process. The ADHD side wants novelty, stimulation, change, urgency, the next thing to chase.

The internal experience is a constant negotiation between the two. A constant wanting to be settled, and rarely finding yourself settled.

And this isn’t just how it feels. A 2023 study scanned the brains of people with autism alone, ADHD alone, and AuDHD. In ADHD alone, the unstable attention traits traced to a different brain region than they did in AuDHD. This implies that the ADHD part of AuDHD is not the same as standalone ADHD. It’s its own thing, generated by its own unique mechanism. The researchers argued AuDHD should be understood, diagnosed and supported in its own right.

In this article I’ll cover the main aspects of this push/pull, how each one makes us feel, and how we can use the balance it creates instead of blaming ourselves for the friction.

Routine Vs Novelty

For ADHD, routine loses its pull fast. Once something is predictable, the ADHD brain stops getting a reward signal from it, and it starts to feel like a cage.

For autism, predictability is regulating. A known routine reduces uncertainty and the cognitive load of constant decision-making.

For AuDHD, this feels like being restless inside your own structure, and lost without it. Never quite able to win.

You might start a morning routine of waking at a certain time, going outside to get some sunlight, meditating, before breakfast and coffee. It feels amazing for four days, and all of a sudden on day five it feels unbearable.

You built the routine because part of you genuinely needs it, then abandon it because part of you genuinely cannot tolerate it. You then feel like a failure for not sticking to a system you designed yourself.

Your system didn’t fail. It only ever served half of you.

Sensory Seeking Vs Sensory Avoiding

ADHD is sensory seeking. An under-stimulated nervous system reaches for input: loud music, intensity, speed, strong flavors and movement.

Autism is sensory over-responsivity. Some inputs land too hard, like light, noise, texture, and smell.

When you have AuDHD, this feels like a volume control that you can’t operate. It feels like being bored and overwhelmed at the same time.

You might feel like going to the mall on a Saturday afternoon, but once you’re there you become overwhelmed by the noise and bright lights. You then have an argument with your partner, because you decide that you need to leave when you’ve just spent an hour traveling there.

Those experiences were not your fault. Environments were just not designed with your neurological functioning in mind.

Social Connection Vs Social Exhaustion

ADHD has a genuine drive toward people, stimulation, conversation, and connection. People are interesting and energizing.

For autism, social interaction carries a high processing cost: decoding body language, managing sensory load, recovering afterwards. The system needs solitude to reset.

AuDHD is wanting social contact even as it depletes you. You look forward to the event, enjoy it in the moment, and cannot function for the rest of the day. From the outside, this looks like flakiness or introversion. From the inside, it is two true things at once: the wanting and the cost.

This can feel like being lonely and overwhelmed by the same thing. Drawn toward people and unable to afford them.

You’re not flaky or cold. You pay an entry cost for connection that most people don’t, and you’re allowed to plan around it.

Deep Focus Vs Scattered Attention

With ADHD, attention is easily captured and pulled away. Sustaining focus on something that is not intrinsically engaging is genuinely difficult.

Autism is monotropic, meaning attention concentrates intensely into a small number of channels. When engaged with an interest, focus is deep, sustained, and hard to break.

Focus with AuDHD is losing eight hours to a single subject and also being unable to read one page of something that doesn’t grip you. The same person hyperfocuses and cannot focus. Unfortunately, you don’t get to choose which mode turns up.

I have such a huge library of books that I haven’t finished. For me, even if the topic is interesting, if the book has a section that is verbose or somehow boring to me, I often give up halfway through, and by the time I want to read something again, I’m already on a different topic. At the same time, there are certain topics that stay with me for life. For example, I will never be bored of tea, and it’s something I can talk about for hours.

This mismatch between needing depth and being unable to execute on it can feel like being unreliable to yourself. It’s being capable of extraordinary depth and unable to summon basic attention on demand, while being unable to predict which version will show up.

One way to reframe this is to treat each attempt as a learning experience rather than a failure, and try to position yourself in work and activities of deep interest that are aligned with your values.

Analysis Vs Urgency

ADHD runs on urgency and a low tolerance for waiting. The pull to act now, decide now, move now, before the moment or the motivation passes.

Autism has a need to process thoroughly, to gather information, to understand the system before acting, to get it right.

For AuDHD, decisions become a trap. Either you research something exhaustively and then cannot commit, or you act on a sudden impulse and skip the analysis you needed. You can also do both about the same decision, months of research, then a five-minute impulsive call.

This shows up in all areas of life. One example for me is that I often spend a lot of time researching and analyzing a purchase, especially if it’s related to a special interest like tea. I will spend so long analyzing the decision that I become fed up with it and switch to a different task. Then the next day, I’ll impulsively order four boxes of a tea I haven’t even tried before. Needless to say, I have more tea in my cupboard than any person could consume in a lifetime. I’ve also decided to quit jobs or move countries in the space of a few hours, more than once.

This can make you feel paralyzed by thoroughness, while feeling reckless from impatience. Never the right amount of either.

Neither mode is the enemy. The skill is borrowing patience from one side and decisiveness from the other, on purpose instead of by accident.

Building Structure Vs Rejecting Structure

ADHD is resistance to your own systems. The plan feels constraining, the planner goes unopened, the framework gets abandoned.

Autism has a desire to systemize, to build the planner, the framework, the process, and to rely on it consistently.

With AuDHD, you are both the person who builds the system and the person who rebels against it. You are excellent at designing structure and unreliable at living inside it.

You implement a new planner or productivity app every few weeks, and abandon each one once the novelty fades.

You know exactly what system would help, but you’re unable to keep using it. This feels like you’re constantly working against yourself, like being a demanding manager and a resentful employee at the same time.

The structure is not wrong. It is being asked to satisfy a part of you that experiences it as confinement.

Order Vs Chaos

With ADHD, clutter accumulates faster than you can manage it. Out of sight is out of mind, so things stay out and pile up. You have a perfect organization system where everything has its own place. The problem is that to the outside world that system looks like a mountain of clothes on your sofa.

Autism has a preference for environmental order. Things in their place. Visual and physical order is calming and reduces cognitive load.

The problem this creates for AuDHD is that you want the ordered environment and generate the chaotic one. The mess is genuinely distressing to the autistic side and genuinely produced by the ADHD side. Tidying is hard to initiate, and the disorder it would fix is actively uncomfortable to live in.

This shows up as:

• Needing surfaces clear to think, and having surfaces covered because putting things away is an executive cost.

• Keeping things visible so you don’t forget them, and being agitated by the clutter.

• A deep tidy that brings real relief, followed by gradual re-accumulation within days.

It feels like constantly being distressed by your own environment. Wanting calm order and living in visible chaos you can’t seem to stay on top of.

This isn’t laziness. It’s a memory system that needs things visible colliding with a nervous system that needs them gone.

Emotional Over-Activation Vs Shutdown

With ADHD, emotion arrives fast, loud and intense, and hard to modulate in the moment.

With autism, when input exceeds capacity, the system can shut down, resulting in withdrawal, flatness, loss of words, or meltdown.

For AuDHD, emotional life oscillates between high-amplitude reactivity and shutdown. The intensity can overwhelm the system into shutdown, and the shutdown can feel like a separate failure on top of the intensity. The two don’t cancel out, they alternate.

This can show up as reacting angrily to something that offends you, causing an argument, then becoming completely overwhelmed and unable to engage in the discussion.

It can feel like too much, and then nothing, rarely a stable middle ground.

It’s hard to know how to deal with this, because emotions are something that shouldn’t be suppressed, and when we suppress them too much in the form of masking, it leads to damaging ourselves for the sake of others’ convenience.

I typically manage this by avoiding deep discussions with people I know I disagree with, and when I do have an emotional reaction, I just accept that this is the way my mind deals with certain interactions rather than judging myself.

The push/pull between autism and ADHD isn’t always a conflict like the examples above. The two can also modulate each other, balancing each other out in interesting ways with positive outcomes:

• The ADHD pull toward novelty can loosen autistic rigidity, making change and spontaneity more accessible than they might be for someone autistic without ADHD.

• The autistic pull toward structure and depth can give ADHD energy somewhere to land, turning scattered drive into sustained, systematic work when an interest aligns.

• Autistic pattern-recognition and depth combined with ADHD associative speed and idea-generation can produce a genuinely distinctive way of thinking and working.

It’s a constant balancing act, but we can make it easier by not judging ourselves for the outcomes of the friction, and designing our lives around the strengths this balance creates.

Have a great week,

Rich

I recently decided to try wearing the sunflower lanyard to public appointments. Up until now I hadn’t felt like it was necessary for me. I guess because my ADHD and autism are what you would call in the “high-functioning” range, even though it doesn’t feel that way sometimes. I always felt that the lanyard was more for those who have it worse than me, and struggle more to deal with public situations.

But every single time I’ve had an appointment with a physio or doctor in the last five months of being back in the UK, I have had some kind of issue. Yesterday was probably one of the most extreme examples. I went to the doctor to ask for some medicine for my chronic pain, which has been getting significantly worse due to mismanagement from multiple physios and doctors.

He suggested trying an opioid. The problem with that is that I had already done my research on chronic pain management, and I was aware that opioids do not have strong research behind them for long-term chronic pain management. I also don’t fancy becoming addicted to opioids 🤷

On the other hand, Duloxetine, which doesn’t carry the same addiction risk, has stronger evidence behind it for long-term chronic pain. As soon as I brought this up in a polite, non-judgemental way, the whole tone of the meeting changed. He started to make counterproductive comments like “you know, if the Duloxetine doesn’t work you’ll just be back to square one, right?” He then started to tear into me about how I should check my sources. The irony is that I had done that, and it was his comment about Duloxetine not being used for musculoskeletal pain conditions that was actually the inaccurate claim.

I of course didn’t mention that, but as he became quite intense with me, I calmly asked him to calm down. This seemed to trigger him. He kicked me out of his office and refused to give me my Duloxetine prescription, so I hobbled off with my crutches to the receptionist, who informed me that I would need to call my doctor the following Monday to make a new appointment. She seemed to realize that the situation wasn’t right, as she apologized to me.

There are a few aspects of this interaction that highlight the inequalities, and difficulties we face as neurodivergent people trying to function in society:

Critical thinking and preparation, which are common in autistic minds, are punished by institutions that promote and reward ignorance and incompetence.

We are all expected to sit there and quietly listen while “high status” people shout flawed arguments at us. For some of us, that is not possible.

When we ask for some consideration, we are denied the basic services that neurotypical people so freely access.

Many of us don’t require extra consideration in most scenarios beyond being treated in a decent, respectful way. It’s not the fact that we’re having to interact with people. It’s that we’re forced to interact with people who are afraid of critical thinking, and the type of problem-solving and preparation that often needs to go into every meeting for an autistic mind.

I don’t need a lanyard because there is something wrong with the way I interact with others. I need one because neurotypical society has designed institutions that train people to act like assholes.

Good luck navigating assholes and have a great week!

Rich

It’s an understatement to say that standard career advice doesn’t work for neurodivergent people.

Left unchallenged, it can ruin our lives.

The frameworks that most career coaches, advisors, and well-meaning parents rely on were not built with our brains in mind. They assume a level of consistency, predictability, and conformity that many of us simply cannot sustain.

I’m AuDHD, and I’ve been on the receiving end of this mismatch for most of my adult life. A chaotic education path, a string of jobs that never lasted more than 18 months, and a late diagnosis that reframed everything. This article is about why that happened. Not just to me, but to so many of us.

Whether you have ADHD, autism, or both, the problems with standard career advice tend to follow a pattern. It ignores what actually matters to you. It confuses what you can do with what you can sustain. It assumes a linear path that doesn’t reflect how your identity and interests evolve. And it makes a series of assumptions about how your brain works that simply aren’t true.

Ignoring Intrinsic Meaning and Interest

The biggest problem with standard career advice is that it often doesn’t take into account your interests, or the causes that you actually care about. It focuses on what will make you the most money, or which roles are in high demand. There’s an overemphasis on economics and external success, or what I call objective success. The kind of outcomes that our parents’ generation saw as successful, but that have no subjective intrinsic meaning.

I know this pattern intimately. When I landed a graduate role at a top-tier US investment bank, my family and their friends were impressed. I’m not going to lie, it felt good. I had naively achieved the kind of objective success that gives people status in society. But once the novelty wore off, something was missing. Some of the work was challenging, and I enjoyed the problem-solving aspect of building software, but there was no intrinsic meaning in developing trade tracking software. I stayed around 18 months before leaving. That kicked off a chaotic career pattern of getting fed up and moving on every 6 to 12 months.

What I didn’t understand at the time was that this wasn’t a motivation problem or a character flaw. As someone who is AuDHD, my ADHD requires interest and novelty to maintain motivation and sustain work over long periods. Without meaning, tasks become neurologically inaccessible. My autism makes me driven by deep values and specific interests, and misalignment leads to chronic withdrawal and disengagement. It becomes impossible for me to stay on the wrong path. AuDHD requires both meaning and stimulation, which is harder to satisfy and leads to a higher mismatch risk. It requires a very specific framework to ensure career sustainability, which doesn’t yet exist.

Standard career advice doesn’t account for any of this. And when you follow it anyway, it often leads to a cycle of false starts, burnout, and career instability — even when you’re capable of much more.

Over-Reliance on Strengths Vs Sustainability

As Product Lead at a Fintech startup in Barcelona, I had a lot of potential on paper. My creativity and ability to think laterally meant I could come up with solutions to problems that others couldn’t see. But none of that mattered when I was sitting in a room with five salespeople all talking loudly over each other, none of them listening to what each other were were saying, and the sensory overload making it impossible for me to even consider choosing one of them to focus on. This is what happens when careers are built on strengths alone. Neurodivergent people end up in roles that look like a great fit on paper, but in environments that are impossible to sustain, solving problems we don’t care about.

This is what an over-reliance on strengths looks like. Standard career advice is oversimplified. There is an emphasis on understanding your strengths, and an assumption that if you can do the job, then you should do it. Existing frameworks already struggle to translate strengths into actual careers, and they also make a dangerous assumption. Just because you are good at something, it isn’t a reason to do it five days a week for the rest of your career.

Sustainability means asking a different set of questions. Can you tolerate the sensory environment day after day? How much does the role cost you outside of work hours? A job might use your strengths perfectly but leave you with nothing at the end of the day. For ADHD, strengths without interest fade fast. You might be objectively good at something, but if it doesn’t hold your attention, your performance will decline regardless of ability. For autism, working against your values or in a role that requires you to suppress who you are creates a slow erosion that no amount of talent can compensate for.

For AuDHD, these factors compound. You need interest and novelty, sensory tolerance, values alignment, and manageable recovery demands all at the same time. The more of these you need to get right, the narrower the viable career options become, and the more dangerous a strengths-only framework is. Standard career advice doesn’t even acknowledge most of these factors exist, let alone help you navigate them.

A Linear Career System

This is more of a systemic problem than an advice problem, but it obviously affects career advice, and it’s one of the biggest problems we face as neurodivergent individuals. Career paths are assumed to be chosen early, stable, and forward moving. This creates multiple problems. We are forced to choose one path early on, and the pressure to get it right at a young age is immense. At the same time, it creates an even greater need for an effective career advice framework, which currently doesn’t exist.

This linearity is baked into hiring policies, and it means that the entries on your resume, over time, more concretely determine the jobs you are able to pursue. We’re expected to stay in roles for minimum periods of time to be deemed eligible for jobs further down the line. These rules create an uneven playing field for neurodivergent people, and help explain the depressing employment statistics.

Identity and interests evolve frequently in ADHD minds, requiring frequent changes and non-linear paths. These are penalised by hiring managers. Autistic individuals may stay in roles for longer, but if the role or environment is misaligned, they might burnout before they can even consider changing to a different role. AuDHD creates an internal conflict with a desire for stability, coupled with a need for change, that is not reflected in most linear career pathways.

For those who are late-diagnosed, like myself, this can create a conflicting situation. The relief of diagnosis and reframing past failures is real, but it’s often followed by a deep period of self-discovery. This is great in many ways, as it can lead to realizations about what is actually meaningful to us, and what we need to build a sustainable career and life. The problem is that what we need is often quite different to the situation we find ourselves in, and the pool of options we have available to divert from the linear path decreases with age. This can make it difficult for us to navigate to a place of alignment.

Essentially we have created a system that at best rewards linear career paths, and at worst enforces them. At the same time there is no relevant early career guidance, and a significant lack of options to change career later in life. This is compounded for those without a financial safety net.

Lack of Structured Career Experimentation

This issue is directly linked to the problem of linear career paths, and each one compounds the other. What I’m talking about here are the flawed processes by which we decide on careers and pursue them. This is mostly a problem for early-stage career exploration, but it also becomes an issue for those who need to change direction later on, whether that is due to poor early choices, identity realization from late diagnosis, or both.

The current method for choosing and pursuing a career often involves sitting down with a coach, a career advisor, or your parents, working out your strengths, determining what possible career paths fit them, then reading about those careers to understand which one you feel best about in theory. That then leads to a decision. Depending on the choice, it often leads to a 3-4 year degree, costing tens of thousands (or more), and a rigid journey into societal contribution. This is a recipe for disaster for neurodivergent people.

ADHD requires exploration and trial and error. A lack of those things results in impulsive changes, or worse, getting stuck and burning out. Autism may commit deeply to a specific path, but if that path ends up being misaligned with values or an incompatible environment, the cost is masking, and inevitably burnout. AuDHD requires exploration and stability, but without testing a particular path in advance, it can often lead to an unsustainable situation.

Career changes later in life have an even higher cost, and without proper experimentation you can find yourself in a similar, or even worse situation. A relevant framework for neurodivergent career design needs to account for both early career choices and later career transitions. It also needs to build in experimentation to reduce the risk of assumptions.

Assumptions About Your Brain

Assumption of stable motivation and energy

Society assumes that if a role fits, we can all sustain effort consistently over time. For ADHD, motivation is interest-based, not importance-based. We can care deeply, but still be unable to act. This results in bursts of hyper-focus followed by inability to initiate, and the inability to engage with tasks we find boring is always real.

Autism can sustain effort, but at a high cumulative cost. The sensory and social load, combined with masking to appear “normal”, can lead to delayed burnout rather than visible inconsistency. For AuDHD, the constant battle between needing stimulation and craving stability leads to unstable engagement patterns. An example is how the last week has gone for me. I had a deep desire to post an article every Monday, but after an intense few weeks of writing I had an idea for a new direction that could be better suited to me and more impactful. The overwhelm that the change caused me made it impossible for me to get started again for about a week.

Assumption that work environments are neutral

Typical work environments assume that everyone can function in the same space. For neurodivergent people this is one of the biggest challenges we face at work. Environment should be a core variable in determining job suitability for neurodivergent individuals.

This has become a lot more flexible in the last ten years, with tech companies leading the way on remote working and covid forcing a new way of working for companies that might not have considered it a viable option. But the problem remains. Many companies still insist on forcing employees to come to the office, even if the environment they have created is basically a form of torture for people who don’t feel they can be themselves around their peers in the office.

ADHD struggles with the understimulation of working at home alone, and benefits from the structure the office brings. But we’re also overstimulated and unable to focus in office environments with too many distractions. For autism, the unpredictability of interruptions, social expectations, and general sensory overload of being confined to a space with bright lights and lots of other people leads to masking. AuDHD suffers from a particular combination of these traits, leaving us feeling like we need the office, but also not really wanting to be there.

To cap it off, we’re made to feel like frauds for using accommodations that are available to us, due to an unsympathetic society that believes everyone should work in the same way, regardless of the imbalance, suffering, and neurodivergent unemployment rates this attitude creates.

Assumption of executive functioning

Jobs are evaluated based on skills and experience, without consideration of the execution demands they place on you. ADHD’s issues with planning, prioritisation, and task initiation lead to burnout via daily friction. Autism works well with clear structure, but struggles with ambiguity and the shifting demands that come with many roles in industry. AuDHD needs structure but struggles to maintain it.

This assumption that everyone can manage their work in the same way makes it unsurprising that people with ADHD experience significantly higher rates of job instability, including more frequent job loss, underemployment, and difficulty maintaining consistent performance. Executive function deficits directly predict burnout and job instability.

Assumption of social functioning

Career advice ignores the cost of social interaction and the lengths some neurodivergent people go to in order to fit in with their peers. ADHD comes with social inconsistency. Our attention and ability to communicate fluctuate throughout the day. Autism comes with the high cost of sustained self-monitoring. For many of us masking becomes the default career strategy where career advice has failed. AuDHD social interaction is both draining and inconsistent. The expectations of consistency lead to burnout, and often a complete lack of ability to participate in society independently at all.

Living with all of this is extremely difficult, and it takes a special kind of strength to make it through to the other side of career misalignment. The corporate world is unlikely to sufficiently adapt to us any time soon. Many of us turn to self-employment or freelance work to take back control, and that comes with its own challenges.

But recognising the problems is the first step. If you’ve spent years feeling like you’re failing at something everyone else seems to manage, it’s worth considering that the system was never designed for the way your brain works. The failures aren’t yours. They belong to a system that was never built to account for you.

I’d love to hear your experience. Which of these problems has hit you the hardest? Drop a comment below.

Have a great week,

Rich

If you have ADHD, you’ve almost certainly been told to “just breathe.”

Probably by someone who meant well — or worse, by someone who didn’t. One thing is for sure: it probably felt almost insulting.

I remember this vividly from my first Vipassana meditation retreat. The monk told us to increase our meditation time by five minutes each day — even though I was already struggling to stay focused for five.

Moments like that made me realise how often ADHD struggles are misunderstood — even in environments that are meant to support regulation.

Just breathe. Just calm down. Just focus.

These phrases land badly for a reason: they imply that regulation is simple — that all you need to do is decide to be calm, and your body will cooperate. For most people with ADHD, that is not how it works. The gap between knowing you need to calm down and actually being able to do it is not a character flaw — it is a nervous system issue.

So when I write about breathwork and ADHD, I want to be clear: this is not just another version of “just breathe.” Structured breathwork — specific, intentional breathing practices with defined patterns and rhythms — is something quite different.

There is a growing body of evidence showing that deliberate breathing practices can influence how the nervous system functions, shift the body’s stress and arousal levels, and support the kind of real-time self-regulation that ADHD makes difficult (1, 2, 3).

This distinction matters. We are not talking about taking a deep breath and hoping for the best. We are talking about using breath as a lever — one that is always available — to influence brain state, nervous system flexibility, and emotional reactivity in measurable ways.

In this article, I’ll cover:

• How ADHD affects nervous system regulation — beyond the dopamine story

• The neuroscience and physiology of how breathing changes brain and body states

• Why breath training can build lasting regulation capacity through neuroplasticity

• How breathwork helps with common ADHD challenges: overwhelm, sleep, emotional intensity, focus, and task initiation

• How to get started safely, including important contraindications

• How breathwork and medication play complementary roles

• Realistic expectations and honest limitations

ADHD and Nervous System Dysregulation

The popular understanding of ADHD often reduces it to a simple dopamine deficit. While dopamine signalling is part of the picture, this framing misses something fundamental: ADHD involves broad dysregulation of the autonomic nervous system (ANS) — the body’s core infrastructure for managing arousal, stress, emotion, and attention (4, 5).

The ANS has two primary branches. The sympathetic branch drives activation — your accelerator — responsible for alertness, mobilisation, and the fight-or-flight response. The parasympathetic branch, anchored by the vagus nerve, drives recovery — your brake — responsible for rest, digestion, and the calm engagement needed for sustained focus.

In neurotypical functioning, these systems work in flexible coordination. Arousal rises when needed, settles when the demand passes. The system adapts. In ADHD, this coordination is often disrupted.

With ADHD, the nervous system doesn’t flex and adapt the way it should — it under-reacts when it needs to step up, and struggles to settle when the demand passes (4). It can look like lying in bed waiting to relax, while your mind keeps searching for stimulation — half on your phone, half elsewhere, never fully landing anywhere. The body is technically at rest, but the system never really downshifts.

The ADHD nervous system exaggerates stress responses, over-firing in ways that fuel both emotional reactivity and impulsivity (4). During emotional tasks, the ADHD nervous system struggles to engage its calming mechanisms — and interestingly, this pattern seems to be driven more by inattention than by hyperactivity (6, 7).

This suggests the issue isn’t simply stronger emotions, but a failure of regulation. The system activates as expected, but struggles to downshift — meaning the physiological side of the emotion can linger long after the trigger has passed. I’ve noticed this myself: even when I know something isn’t a big deal anymore, my body can still feel like it is.

What this means is that the ADHD nervous system often struggles with arousal regulation in several specific ways:

• Arousal variability: The system oscillates between states — sometimes too activated (anxious, overwhelmed), sometimes too deactivated (shut down)

• Emotional intensity: Emotional dysregulation isn’t just a side-effect of ADHD — it may be a core feature, showing up early in childhood and persisting into adulthood (8)

• Stress sensitivity: The ADHD nervous system tends to tip into fight-or-flight more readily and recover more slowly

• Sleep disturbance: Difficulty winding down at the end of the day is one of the most common complaints in ADHD. The system stays on when it needs to switch off

• Difficulty with transitions and task initiation: When the nervous system is dysregulated, transitions become effortful and sometimes paralysing

Understanding ADHD through this lens — as a condition involving nervous system regulation, not just attention — opens up a different set of possibilities. If the problem involves nervous system flexibility, then interventions that directly influence how the nervous system functions become worth investigating. This is where breathwork enters the picture.

The Neuroscience and Physiology of Breathwork

Breathing is unique among the body’s automatic functions. It runs on its own, but it can also be deliberately controlled. This dual nature makes it a bridge between the conscious mind and the involuntary nervous system.

Vagus nerve activation

The vagus nerve is the main nerve of the parasympathetic nervous system — the body’s rest-and-recovery system. It runs from the brainstem down to the heart, lungs, and gut, acting as a direct communication line between the brain and the body. Slow, controlled breathing — particularly with a longer exhale than inhale — stimulates the vagus nerve, signalling to the body it’s safe to shift out of stress mode and into recovery (1, 9).

Slow breathing reliably improves heart rate variability (HRV) — a key marker of how well your nervous system can adapt to what’s happening around you — both during practice and with regular training over time (2). I notice a tangible shift after just a few minutes of slowing my breath — not instant calm, but a clear reduction in mental noise and physical tension. The things I’ve been worrying and ruminating about all day often seem to loosen their grip — as if the emotional intensity behind them has dropped enough for me to see them more clearly.

Heart rate variability (HRV)

Your heart doesn’t actually beat at a perfectly steady rhythm — there are tiny variations in the time between each beat, and these variations tell us a lot about how your nervous system is functioning. Higher HRV means your system is flexible and responsive. Lower HRV suggests a system that’s stuck — either locked in stress mode or struggling to adapt.

Breathing at around six breaths per minute — often called coherent breathing — hits a sweet spot where your breathing rhythm and your cardiovascular system start to sync up. This amplifies HRV and helps the body regulate blood pressure and heart rate more efficiently (3, 10).

One of the useful things about HRV is that you can see it changing in real time. HRV biofeedback training uses sensors to show you your heart rate variability as you breathe, so you can literally watch your nervous system shift as you practise. I might be covering this in more depth in a future article — if that’s something you’d find useful, let me know in the comments.

Respiratory chemistry and CO₂ tolerance

Breathing patterns directly affect blood chemistry. When you over-breathe — which is very common in anxious states — carbon dioxide levels in the blood drop. This narrows blood vessels, reduces oxygen delivery to the brain, and produces symptoms like dizziness, muscle tension, and heightened anxiety — sensations that can feel like panic and make the anxiety worse (11). Slow, controlled breathing helps restore healthy CO₂ levels and retrain the body’s respiratory reflexes, reducing sensitivity to these false alarms (9, 10).

Limbic system modulation

Controlled breathing influences the amygdala — the part of the brain that detects threats and triggers emotional reactions. Over time, sustained breathwork practice may reduce amygdala reactivity while also strengthening the prefrontal cortex — the brain region involved in decision-making, impulse control, and managing attention (12).

Interoception

This is your ability to notice what’s happening inside your own body — your heartbeat, hunger, tension, or rising stress — and this ability is often reduced in ADHD (13). Breathwork naturally trains this skill by repeatedly directing your attention inward: noticing the rise and fall of your breath, feeling your heartbeat, sensing when your body is starting to tense or settle.

The physiological sigh

A 2023 Stanford study compared three breathing techniques and mindfulness meditation over one month. The standout finding was that cyclic sighing — a double inhale through the nose followed by a long exhale — produced the greatest improvements in mood and the biggest reductions in physical stress markers, outperforming even mindfulness meditation (14). This pattern, known as the physiological sigh, appears to be one of the fastest ways to shift the nervous system out of stress mode.

Why Breathwork Training Matters for ADHD

A single breathing exercise can shift your state in the moment. That alone is useful. But the deeper value of breathwork for ADHD lies in what happens with consistent practice over time.

Neuroplasticity and structural change

The brain adapts to what it practises repeatedly. Research on meditation and breathwork has shown measurable physical changes in the brain: the prefrontal cortex — the area responsible for focus, planning, and impulse control — gets stronger, the connections between attention-related brain regions become more efficient, and neurotransmitter systems including dopamine become better regulated (12, 15). Research has shown that adults with ADHD who practised mindfulness-based techniques experienced significant reductions in ADHD symptoms (16).

Autonomic conditioning

Just as regular exercise trains your cardiovascular system to work more efficiently, breathwork trains your nervous system. Repeated practice of slow, regulated breathing strengthens vagal tone over time — essentially giving your nervous system a stronger brake (2). For a nervous system that defaults to being dysregulated, this matters enormously — it means the system gradually becomes better at self-regulating even when you’re not actively practising.

Learning intentional state shifts

One of the most practically valuable aspects of breathwork for ADHD is learning to deliberately shift between nervous system states. Rather than being passively carried by waves of activation or shutdown, breath training develops the capacity to recognise your current state and choose a practice that moves you toward a more functional one. Over time, this becomes less effortful and more instinctive.

Increasing regulation capacity

There’s a useful concept called the “window of tolerance” — the range of stress and stimulation within which you can still think clearly, manage your emotions, and function well. ADHD often narrows this window, meaning it takes less to push you into overwhelm or shutdown. Breathwork, practised consistently, appears to widen it — gradually increasing how much you can handle before your regulation breaks down.

This is the critical reframe: breathwork is not just a calming technique for acute moments of distress. It is a trainable regulation skill that, with practice, can reshape how the nervous system operates at baseline.

State-Based Breathwork for Common ADHD Challenges

Different nervous system states call for different breathing approaches. What follows is a science-informed overview of how breathwork addresses the most common ADHD-related challenges, along with the specific practices most relevant to each. Some practices are beneficial for multiple states, so there is some overlap.

Anxiety and Overwhelm

Anxiety in ADHD is a full-body state — the nervous system gets stuck in overdrive, producing stress signals faster than the body’s calming systems can counterbalance them.

Slow breathing with a longer exhale directly interrupts this cascade — it activates the vagus nerve, restores healthy carbon dioxide levels, and shifts the nervous system back toward recovery mode (1, 2, 3). Humming-based practices like bhramari may take this further by adding gentle vibration through the throat, which may stimulate the vagus nerve directly. Research suggests even brief humming sessions can produce measurable improvements in nervous system flexibility (17).

Practices: Diaphragmatic breathing, Physiological sigh, Box breathing, Pursed-lip breathing, Coherent breathing, Bhramari

Sleep and Hyperarousal

Sleep difficulty in ADHD is fundamentally an arousal problem. The nervous system fails to downshift from daytime activation to the rest-and-recovery state needed for sleep.

Breathing practices that use slow rhythms and a long exhale help push the nervous system into its rest-and-recovery state and reduce physical activation. The 4-7-8 pattern — inhale for four counts, hold for seven, exhale for eight — is specifically designed to force this shift, using the long hold and extended exhale to slow everything down. This is my go-to tool for evening relaxation — I also use it when I’m ready to go to sleep. Body scan breathing combines breath awareness with a systematic scan through the body, helping to notice and release tension you might not even realise you’re carrying (3, 14).

Practices: 4-7-8 breathing, Coherent breathing, Body scan breathing

Emotional Regulation

Emotional dysregulation in ADHD has two sides: emotions hit fast, and they take a long time to come back down. Because the nervous system is less flexible, the physical side of emotion — the racing heart, the heat in your chest, the tension — can hang around long after the trigger has passed (6, 8).

Breathwork supports emotional regulation in several ways. Activating the vagus nerve dampens the body’s stress response directly. Body-awareness practices help you notice emotions building before they take over — creating a crucial gap between the trigger and your reaction. Rhythmic breathing calms the brain’s emotional centres (12). Alternate-nostril breathing (nadi shodhana) has been linked to balancing nervous system activity between its activation and recovery modes, while humming practices provide both vagus nerve stimulation and a calming auditory focus.

Practices: Body scan breathing, Nadi Shodhana, Bhramari, Diaphragmatic breathing

Focus and Attention

Focus problems in ADHD come from several things happening at once: the brain’s attention-management regions are underpowered, the “mind-wandering” network doesn’t quiet down when it should, and arousal levels keep shifting unpredictably. When arousal is too low, the system can’t sustain focus. When it’s too high, attention scatters. The sweet spot — calm alertness — is where sustained focus becomes possible.

Breathing practices that create a steady, rhythmic state in the nervous system support this kind of calm alertness. Coherent breathing at around six breaths per minute synchronises the body’s respiratory and cardiovascular rhythms, creating a stable base for sustained attention (10). Ujjayi breathing — with its gentle throat constriction and soft audible quality — gives the mind a continuous sensory anchor that can help maintain present-moment focus. Breath counting and attention meditation engage the brain’s focus regions in a repetitive task that, over time, strengthens the very networks ADHD leaves under-developed (15, 16).

Practices: Attention meditation, Breath counting, Ujjayi, Coherent breathing

Task Initiation and Transitions

The inability to start tasks — or to shift between them — is one of the most practically disabling aspects of ADHD, and it has very little to do with laziness or not caring enough. Starting a task requires a specific nervous system gear-shift: from rest or avoidance into action, without tipping into overwhelm.

Short, structured breathing practices can work as transition rituals — brief resets that help the nervous system shift gears. The physiological sigh provides a rapid calming effect that clears residual stress from whatever you were doing before. Box breathing creates a controlled, balanced rhythm that steadies the nervous system without making you sluggish — a useful bridge between states. Walking breathwork combines gentle movement with rhythmic breathing, recruiting the body’s motor systems to help initiate the shift from inertia to action (10, 14).

Practices: Box breathing, Physiological sigh, Walking breathwork

Calming the Nervous System

Beyond specific symptom states, there is the broader need in ADHD for practices that build baseline nervous system calm — reducing the chronic low-grade activation that makes everything else harder. This is where consistent, daily practice has its deepest value.

The practices in this category are all about sustained activation of the body’s rest-and-recovery system. Diaphragmatic breathing engages the lower lungs — where blood flow is richest — which promotes better oxygen exchange and stimulates the vagus nerve. Coherent breathing at six breaths per minute maximises heart rate variability. Nadi shodhana (alternate nostril breathing) and bhramari (humming breath) add further calming effects through controlled nasal airflow and gentle vibration (1, 2, 17). Extended coherence breathing — longer sessions of coherent breathing — builds cumulative nervous system resilience over time.

Practices: Diaphragmatic breathing, Coherent breathing (extended), Nadi Shodhana, Bhramari

How to Get Started with Breathwork Safely

Some breathwork techniques have genuine contraindications, and I repeat that unapologetically. You should speak with a doctor or qualified medical professional before beginning any breathwork practice if you:

• Have cardiovascular conditions

• Have respiratory conditions such as asthma or COPD

• Have neurological conditions including epilepsy

• Have psychological conditions such as PTSD, panic disorder, or a history of psychosis

• Are pregnant

If you are unsure whether breathwork is appropriate for you, err on the side of caution and consult a medical professional first.

It is also worth being cautious about jumping straight into practices you find on apps or social media. Breathwork and mindfulness fall under the wellness industry, which is completely unregulated — anyone can create content, including audios or guides, and put them out there for people to find.

Some methods — such as Wim Hof, holotropic breathing, or other practices involving rapid breathing, prolonged breath holds, or long sessions — can be highly activating, physiologically intense, and genuinely dysregulating for beginners.

I’m not saying these practices are inherently wrong, but they are not where most beginners should start. Starting with intense practices like these — often found on meditation apps — was one of my early mistakes with breathwork.

Begin with simple, regulation-focused practices. Slow diaphragmatic breathing with a gently extended exhale is one of the most evidence-supported starting points: it is gentle, accessible, and directly activates the calming pathways that support regulation (1, 2, 14). This article introduces a five-minute breath reset practice using diaphragmatic breathing with a long exhale.

Breathwork and ADHD Medication: Complementary Roles

Breathwork and medication support different dimensions of ADHD functioning, and for many people the most effective approach involves both.

ADHD medications — including stimulant and non-stimulant treatments — primarily influence neurotransmitter signalling in brain networks involved in attention, executive control, and motivation. This can improve sustained focus, task persistence, and the ability to organise and follow through. These are important cognitive effects that breathwork does not directly replicate.

Breathwork, by contrast, primarily influences physiological state regulation. Through changes in breathing pattern, heart rate dynamics, autonomic balance, and interoceptive signalling, structured breathing practices can support emotional regulation, anxiety reduction, sleep onset, nervous system recovery, smoother transitions between states, and real-time self-regulation during moments of overwhelm or shutdown.

Both approaches act on the nervous system, but through different mechanisms and on different timescales. Medication may help stabilise the neural conditions required for sustained cognitive performance. Breathwork may help stabilise the physiological and emotional conditions required for feeling regulated enough to engage. For many adults with ADHD, these forms of support are complementary rather than interchangeable.

A balanced approach may involve drawing on the benefits of evidence-based medical treatment while also exploring self-regulation practices that remain under-integrated in standard care, such as breathwork or mindfulness, despite a growing body of supportive research.

Limitations and Realistic Expectations

It would be irresponsible to write about breathwork for ADHD without being clear about what it is not.

Breathwork is not a cure for ADHD. ADHD is a neurodevelopmental condition with genetic, neurological, and environmental dimensions. No breathing practice changes that.

The research base is promising, but still developing. While there is strong evidence that slow breathing improves nervous system function and psychological wellbeing in the general population (1, 2, 3), and growing evidence that mindfulness-based approaches help with ADHD specifically (16), large-scale clinical trials looking directly at breathwork for ADHD are still limited.

Much of what we can say involves applying well-established breathing and nervous system research to the ADHD context — a reasonable and evidence-informed inference, but not the same as direct proof.

Individual responses vary. Some people notice immediate effects; others need weeks of consistent practice before changes become apparent. Some practices will resonate strongly; others may feel neutral or even unhelpful. This is normal and expected.

Consistency matters more than intensity. Five minutes of daily diaphragmatic breathing will almost certainly do more for your nervous system than an occasional hour-long session. The conditioning effects of breathwork are built through repetition, not heroic effort.

Some practices will help certain states much more than others. Breathwork is not a one-size-fits-all intervention — it is a toolkit. Learning to match the right practice to the right state is part of the skill, and it takes time.

None of this diminishes the value of breathwork as a regulation tool. It simply means approaching it with the same grounded realism we should bring to any intervention.

ADHD is, in part, a regulation condition. It affects how the nervous system manages arousal, emotion, attention, and transitions — the fundamental building blocks of daily functioning.

While there is no single solution that addresses all of these dimensions, the growing body of evidence suggests that structured breathwork offers something genuinely valuable: a direct, always-available means of influencing the nervous system processes that underlie so much of the ADHD experience.

Breathing is not a cure, and it is not magic. But it is a trainable skill. With consistent practice, it can help build the kind of nervous system flexibility that makes regulation less effortful — not by eliminating ADHD, but by expanding your capacity to navigate it.

The practices are available. The science is real. And the starting point is simple: one day at a time, with intention.

All the best with your practice,

Rich

References

1. Gerritsen, R.J.S. & Band, G.P.H. 2018. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Frontiers in Human Neuroscience, 12, 397.

2. Laborde, S. et al. 2022. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, 104711.

3. Shao, R. et al. 2024. The Effect of Slow-Paced Breathing on Cardiovascular and Emotion Functions: A Meta-Analysis and Systematic Review. Mindfulness, 15, 1–18.

4. Geiss, L. et al. 2023. Dysregulation of the autonomic nervous system in adult attention deficit hyperactivity disorder. A systematic review. Cognitive Neuropsychiatry, 28(4), 285–306.

5. Turkoglu, C. et al. 2025. The Relationship Between ADHD and Autonomic Regulation: A Pupillometry-Based Study. Bratislava Medical Journal, 126, 1957–1963.

6. Musser, E.D. et al. 2011. Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of Abnormal Child Psychology, 39(6), 841–852.

7. Morris, S.S.J. et al. 2020. Emotion Regulation via the Autonomic Nervous System in Children with ADHD: Replication and Extension. Journal of Abnormal Child Psychology, 48(3), 361–373.

8. Soler-Gutiérrez, A.-M. et al. 2023. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLOS ONE, 18(1), e0280131.

9. Russo, M.A. et al. 2017. The physiological effects of slow breathing in the healthy human. Breathe, 13(4), 298–309.

10. Lehrer, P.M. & Gevirtz, R. 2014. Heart rate variability biofeedback: how and why does it work? Frontiers in Psychology, 5, 756.

11. Meuret, A.E. et al. 2011. Do unexpected panic attacks occur spontaneously? Biological Psychiatry, 70(10), 985–991.

12. Tang, Y.Y. et al. 2015. The neuroscience of mindfulness meditation. Nature Reviews Neuroscience, 16, 213–225.

13. Bruton, A. et al. 2025. Diminished Interoceptive Awareness in Attention-Deficit/Hyperactivity Disorder: A Systematic Review. Psychophysiology, 62(2), e14750.

14. Balban, M.Y. et al. 2023. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895.

15. Tang, Y.Y. et al. 2007. Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17152–17156.

16. Cairncross, M. & Miller, C.J. 2020. The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review. Journal of Attention Disorders, 24(5), 627–643.

17. Kuppusamy, M. et al. 2016. Immediate Effects of Bhramari Pranayama on Resting Cardiovascular Parameters in Healthy Adolescents. Journal of Clinical and Diagnostic Research, 10(5), CC17–CC19.

You sit down, close your eyes, and observe your breath.

Ten seconds later you’re simultaneously thinking:

• How annoying your boss is

• How much you want to quit your job

• Why is the person who made this audio talking so slow…

By one minute in you’ve already decided to quit your job, planned two new businesses, and decided that meditation isn’t for you.

This isn’t a failure of discipline — it’s a reflection of nervous system dysregulation.

Attention training meditation is one of the most powerful ways to stabilise focus — but jumping straight into concentration can feel frustrating when the nervous system is overstimulated.

This is why combining brief breath regulation with focused attention meditation can make the practice far more accessible.

This is the second article in a series on five-minute mindfulness practices for ADHD. The previous article introduced the five-minute breathwork practice.

In this article, I’ll guide you through a simple five-minute practice designed specifically to train attention. You can access the guided audio by subscribing for free below 👇

Why Combine Breathwork With Attention Meditation?

Short periods of slow diaphragmatic breathing can help bring the nervous system into a calmer and more regulated state before concentration practice.

Slow breathing has been shown to influence autonomic balance, increasing parasympathetic activity and reducing physiological stress (1).

When arousal decreases, cognitive control and sustained attention tend to improve.

Research also suggests that breath-focused practices can enhance emotional regulation and reduce mind-wandering, which may support attentional stability during meditation (2).

From an ADHD perspective, this matters because attention is highly state-dependent.

When the nervous system is dysregulated — overstimulated, anxious, or fatigued — focus becomes much harder.

Beginning with one to two minutes of structured breathing can:

• Reduce restlessness

• Lower background anxiety

• Make it easier to engage with the meditation object

• Increase the likelihood that you complete the session

• Make it easier to sustain meditation for longer.

If you want a deeper explanation of how meditation improves attention control in ADHD, I explored this in detail in my longer article on meditation for ADHD.

The Five-Minute Attention Training Practice

This practice is designed to begin at five minutes. You can extend it simply by lengthening each stage over time.

You can do this sitting upright or lying down.

Set a timer for five minutes, or follow along with the guided audio.

Step 1: Regulate the breath

Close your eyes and begin breathing slowly through the nose.

Aim for a gentle rhythm such as:

• Inhale for around 4 seconds

• Exhale for around 6 seconds

You can experiment with adding a pause of a few seconds between the inhale and the exhale for a deeper activation.

Allow the breath to move into the lower abdomen rather than the chest. This means that your stomach should rise higher than your chest. You can place one hand on your stomach and one hand on your chest to bring awareness to those areas.

You are not forcing the breath — just actively slowing it slightly.

While breathing, lightly notice:

• The movement of the stomach

• The sensation of air passing through the nose

• The overall rhythm of the breath

If thoughts arise, return focus to the next breath.

Repeat the rhythm for one to two minutes, and if at any point you start to feel uncomfortable, then stop the breathing practice, allow the breath to follow its natural rhythm, and move into the attention meditation.

At some point you will feel the mind and body become noticeably more relaxed — this can be a good time to transition to meditation.

The goal here is simple: settle the nervous system enough that attention becomes easier to stabilise.

Step 2: Shift into attention training

Now allow the breath to return to a natural rhythm.

You are no longer actively controlling the breath, but observing its natural rhythm.

Bring your attention to one small sensory point — the physical sensation of breathing at the nostrils.

Notice:

• Coolness as you inhale

• Warmth as you exhale

• Subtle tingling or pressure

This small area becomes your meditation object.

Your task is not to block thoughts or sensations — only to keep returning attention to the breath when you notice the mind has drifted.

To help stabilise focus, you can count breaths:

• Inhale + exhale = one

• Count up to ten

• If you lose count, gently start again at one

In the beginning, you may not reach ten.

That is completely normal.

Each time you notice attention has drifted and bring it back, you are training attentional control.

Step 3: Maintain peripheral awareness

While attention rests on the breath, maintain a soft background awareness of:

• Sounds

• Body sensations

• Emotional tone

You are not engaging with these experiences — just allowing them to exist while you focus on your breath.

This balance between focused attention and open awareness is central to mindfulness training.

Over time, it helps reduce impulsive reactivity and strengthens the ability to choose where attention goes.

ADHD-specific tips for this practice

Start small and stay consistent

Five minutes is enough to begin training attention.

Longer sessions can be added gradually once the habit feels stable. You can try and increase by five minutes each week, but go at your own pace.

Expect restlessness

Many people with ADHD feel agitated when first attempting meditation.

This often decreases after a short period of breath regulation.

Use structure

Counting breaths, using a timer, or following the audio guide reduces the cognitive load of the practice.

Adjust posture if needed

If lying down causes sleepiness, try sitting upright.

If sitting causes discomfort or pain, lying down is fine.

Link the practice to an existing routine

For example:

• After morning tea or coffee

• Before beginning work

• After exercise

Habit stacking makes consistency easier.

In the early stages, meditation may feel chaotic or frustrating.

This does not mean it isn’t working.

Attention training meditation develops a simple but powerful skill:

Noticing distraction and deliberately returning focus.

With regular practice, many people experience:

• Increased ability to stay on tasks

• Faster recovery from emotional reactions

• Reduced impulsive behaviour

• Greater awareness of internal states

These changes tend to emerge gradually.

Five minutes per day, practised consistently, can begin to shift how attention operates.

All the best with your practice,

Rich

Access the audio guides

The Mindfulness for ADHD audio guides are free resources to help people with ADHD build a mindfulness routine. Each audio includes:

• A brief explanation of how to do the practice

• A five-minute guided practice

• A few anchors to bring you back to the breath

• A sound bowl to signal when five minutes is up.

References

1. Zaccaro, A., et al. (2018). How breath-control can change your life: A systematic review on psychophysiological correlates of slow breathing. Frontiers in Human Neuroscience.

2. Lutz, A., Slagter, H., Dunne, J., & Davidson, R. (2008). Attention regulation and monitoring in meditation. Trends in Cognitive Sciences.

You open your laptop with a clear plan for the day.

Suddenly your boss sends you a message on Slack telling you that the whole plan has changed. Everything you’ve been working on all week now feels irrelevant.

You know what you need to do next, but a quiet sense of overwhelm begins to build, and your mind feels as if it’s running faster than you can keep up.

This is a common experience in ADHD. Even small disruptions to routine can quickly destabilise focus and create a sense of mental overload.

This is where a breath reset can help.

A short breath reset can be used:

• During moments of overwhelm

• When anxiety or restlessness starts building

• Before or after stressful situations

• As a transition into meditation

• To support relaxation and pain management

In this article, I’ll introduce a simple breathing practice adapted specifically for ADHD minds.

Paid subscribers can access the breathwork audio guides here.

How Breathwork Helps Regulate the Nervous System

Slow, controlled breathing activates the parasympathetic nervous system, the branch of the autonomic nervous system responsible for rest, recovery, and relaxation. When this system is activated, heart rate slows, stress hormones decrease, and the body shifts out of “fight-or-flight” mode (1).

Breathing patterns directly influence the balance between the sympathetic (stress) and parasympathetic (calming) branches of the nervous system. Slow diaphragmatic breathing in particular increases vagal activity, a key marker of parasympathetic regulation (2).

In practical terms, this means slow breathing can:

• Reduce physiological stress

• Stabilise emotional reactivity

• Improve attention and cognitive control

• Reduce muscle tension and perceived pain

• Support sleep and deeper physical relaxation

Controlled breathing practices can also improve mood and reduce anxiety by regulating physiological arousal (3).

For people with ADHD, this matters because attention difficulties are often linked to problems regulating arousal. When the nervous system is overstimulated or dysregulated, focus becomes much harder.

Breathwork doesn’t “fix” ADHD, but it can help bring the nervous system into a state where attention becomes more accessible.

Important Considerations

This breathing exercise is gentle and safe for most people. However, breathwork can sometimes cause lightheadedness or dizziness if breathing becomes too deep or forced.

You should be cautious with breathwork if you:

• Have cardiovascular or respiratory conditions

• Are pregnant

• Have any medical condition that affects breathing or circulation

If you feel uncomfortable during the exercise, simply stop and return to normal breathing.

If you have any medical concerns, speak with a healthcare professional before trying breathwork practices.

The Five-Minute Breath Reset Practice

I’ve trained in several breathwork approaches, but the most effective technique is often the simplest: diaphragmatic breathing.

This involves breathing deeply into the lower abdomen rather than shallowly into the chest. There are different variations of this, but we will keep it simple, with some options.

You can set a five-minute timer, or allow the practice to transition naturally into meditation as the mind begins to settle.

You can do this sitting upright in a chair or lying down.

The practice

Start by placing one hand on your chest and one on your stomach.

When you breathe in, the hand on your stomach should rise more than the hand on your chest. This indicates that the diaphragm is doing most of the work.

The basic rhythm is simple:

• Inhale slowly through the nose for about four seconds

• Exhale slowly through the nose for about six seconds

• Continue the pattern for around five minutes

While breathing, keep your attention lightly focused on the physical sensation of the breath, the movement of the abdomen or the feeling of air passing through the nose.

When your mind wanders (which it will), gently return your attention to the breath.

Explanation & next steps

Some practices recommend exhaling through the mouth, but nasal breathing may enhance the regulatory effects of slow breathing by improving respiratory efficiency and autonomic balance (3).

The longer exhale is important. Research suggests that extending the exhale phase of breathing enhances parasympathetic activation and relaxation responses (4).

You can experiment with adjusting the length of the inhale and exhale, increasing if that feels right, as you progress in your practice. You will find that you naturally extend the breath time as you progress.

If you want to go slightly deeper, you can add a short pause of a few seconds after the inhale and before the exhale. This can feel slightly more activating, so you might want to practice without a pause to begin with.

The goal isn’t perfect concentration. The goal is simply to slow the breathing and allow the nervous system to settle.

If meditation has felt difficult or frustrating in the past, breathwork can act as a bridge. A simple way to calm the nervous system so that focus becomes possible.

It’s also one of the most practical mindfulness tools to use during the day, even when you’re at the office or around other people. Because it simply involves regulating the breath.

In the next article, I’ll show you how to use this calmer state to begin attention training meditation.

Best of luck with your practice,

Rich

Access the audio guides

The Mindfulness for ADHD audio guides are free resources designed to help neurodivergent people build a mindfulness routine. Each audio includes:

• A brief explanation of how to do the practice

• A five minute guided practice

• A few anchors to bring you back to the breath

• A sound bowl to signal when five minutes is up.

Paid subscribers can access the audio guides here.

References

1. Jerath, R., Edry, J., Barnes, V., & Jerath, V. (2015). Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow breathing shifts the autonomic nervous system. Medical Hypotheses.

2. Lehrer, P., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology.

3. Zaccaro, A., et al. (2018). How breath-control can change your life: A systematic review on psychophysiological correlates of slow breathing. Frontiers in Human Neuroscience.

4. Brown, R. P., & Gerbarg, P. L. (2005). Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression. Journal of Alternative and Complementary Medicine.

Free Resources

The ADHD, Autism, and AuDHD Self-Identification Guide

Self-identification is free and valid. Match yourself against the criteria for ADHD and autism.

The guide breaks down the criteria and adds a plain-language explanation under every criterion, plus a prompt to weigh each one against your own life.

The Neurodivergent Guide to Chronic Pain

In this guide I go deep into managing chronic pain, including in-depth guidance, tools backed by promising research, and links to all the products I use to get through chronic pain life.

The Neurodivergent Guide to Rest

Why rest is so important for us, and how to actually do it with a nervous system that doesn’t want to slow down.

A research-backed toolkit of neurodivergent rest methods, as well as a breakdown of what has worked well for me personally.

The ADHD Focus & Planning System Template

A flexible weekly planning system (Notion template) — designed to reduce overwhelm and help you stay oriented during the week.

It brings your goals, tasks, and realistic work sessions together in one place, making it easier to see what matters and follow through on meaningful work.

This is a simple ADHD-friendly planning system designed to help you stay oriented and make steady progress — even during low-energy or difficult weeks.

Access the ADHD Focus & Planning System Notion template by subscribing for free below 👇

It’s built for people who need structure without rigidity — a clear way to plan what matters while still allowing flexibility when focus or motivation fluctuates.

Instead of relying on distant deadlines or vague intentions, the system centres around:

• Clear weekly goals

• Realistic work sessions

• Externalised task management

• Working with your energy rather than against it

You can keep the system open in a browser tab so you always have a clear view of your week. When you’re ready to work, you simply look at your plan and start the next task — instead of becoming overwhelmed.

How the system works

The system follows a simple weekly rhythm:

1. Set one primary weekly goal

2. Break it into manageable tasks

3. Schedule realistic work sessions

4. Review and adjust each week

If you’d like to understand the thinking behind the system in more depth, you can read the articles here:

• Setting weekly goals

• Managing tasks

• Breaking goals into manageable steps

• Flexible time blocking

• Weekly reviews

Inside the template

Task Database

This is where all tasks live.

You can capture tasks as they arise, organise them by energy level, and schedule them into specific work sessions.

Having one clear place for tasks helps reduce mental load and prevents the “remember → forget → remember again” loop.

Weekly View

This is the main page where you run your week.

It allows you to:

• Define and visualise your weekly goals

• See all scheduled tasks at a glance

• View tasks grouped by day and time

• View and manage your weekly reviews

This page brings your priorities and your schedule together in one place.

Time Blocks

This page helps you design the structure of your week.

You can map out recurring commitments and define realistic work sessions before assigning tasks.

Planning your work sessions in advance reduces decision-making during the week and makes it easier to start.

Start using the system

Access the ADHD Focus & Planning System Notion template by subscribing for free below 👇

You start the week with good intentions. You make a plan, maybe even feel optimistic about what you’ll achieve.

But by the end of the week things look different.

Some tasks were completed. Others were ignored. A few were started but never finished. Sometimes you’re not even sure why.

The weekly review breaks this cycle.

Instead of moving straight into the next week, you take a short moment to look at what actually happened and adjust your system accordingly.

This article is the final part of my ADHD execution system. In the previous articles we covered:

• Weekly goals

• Task management

• Breaking goals into tasks

• Time blocking

Now we’ll look at the final step: reviewing the week and planning the next one.

You can access the ADHD Focus & Planning System Notion template by subscribing for free below 👇

Why Weekly Reviews Work

Planning systems only improve when they include feedback.

Research on self-regulation shows that reflecting on past performance and adjusting future behaviour improves goal achievement and learning outcomes (1). When we regularly review our progress, we become better at estimating effort, identifying obstacles, and adapting our strategies.

For folks with ADHD, this type of structured reflection can be especially useful. ADHD is associated with difficulties in monitoring progress, planning behaviour, and adjusting strategies based on feedback (2).

A weekly review creates a simple feedback loop.

Instead of repeating the same mistakes, you learn from the previous week and adjust the next one.

Over time, this dramatically improves the accuracy of your planning.

The Process

The weekly review has two parts:

1. Review the week

2. Plan the next week

The entire process usually takes around 15–30 minutes, although it may take a little longer when you first start.

Part 1: Review the week

Start by looking at the tasks and time blocks you planned for the week.

Ask a few simple questions.

What did I complete?

Look at the tasks that were finished and the goals that were achieved.

What didn’t I complete?

Identify the tasks that were missed or left unfinished.

Why?

Look for structural reasons rather than blaming yourself.

Common patterns might include:

• Tasks were too large – break tasks down further next week

• The week was over-scheduled – reduce the number of tasks planned

• Energy was lower than expected – schedule more lower-energy tasks

• Unexpected interruptions occurred – leave more buffer space in the schedule

The goal of this step is not judgement.

It is simply identifying adjustments that will make next week easier.

You now have an improved system — and your progress compounds week by week.

Part 2: Plan the next week

Once you’ve reviewed the previous week, you can plan the next one.

Define next week’s goals

Choose a primary goal and, if capacity allows, one or two secondary goals.

These should represent the main outcomes you want to complete during the week.

Rebuild the task list

Break the goals down into tasks and add any additional tasks that need to be completed during the week.

At this stage you should have a clear list of the work required.

Allocate tasks to time blocks

Look at your weekly work blocks and assign tasks to specific sessions.

If you do not already have defined work blocks, create them now by identifying the realistic work sessions available during the week.

Each session should have:

• A primary task

• A lower-energy backup task

Once this is done, the week is planned.

Productivity systems don’t fail because people lack motivation.

They fail because they are never adjusted.

The weekly review creates a simple feedback loop that allows your system to improve over time.

Each week you learn a little more about your capacity, your energy levels, and the type of work you can realistically complete.

Then you adjust and try again.

Over time, the system becomes easier to follow — and progress becomes much more consistent.

Best of luck with your execution,

Rich

Try the ADHD Focus & Planning System Notion template

The ADHD Focus & Planning System is designed to help you plan your week, manage tasks, and work with your energy — not against it.

Inside the system you’ll find:

• A task management database

• Time blocking functionality

• A weekly view that provides:

  • An overview of your weekly goals

  • An overview of your weekly tasks, grouped by day

  • A simple weekly review space

References

1. Zimmerman, B. J. (2002). Becoming a self-regulated learner: An overview. Theory Into Practice.

2. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin.

Even when your goals are clear and your tasks are organised, there is still one common problem.

You sit down to work and think: what should I do right now?

For people with ADHD, this moment can create a surprising amount of friction. The brain suddenly has to decide what to work on, whether the task is important, whether there is enough time, and whether the effort feels manageable.

This small moment of uncertainty can easily turn into procrastination.

Time blocking solves this problem by removing the decision entirely. Instead of deciding what to do in the moment, you decide in advance when each task will be done.

This article is the fourth part of my ADHD execution system. In the previous articles we covered:

• Weekly goals

• Task management

• Breaking goals into tasks

Now we’ll look at the next step: scheduling those tasks into realistic work sessions.

You can access the ADHD Focus & Planning System Notion template by subscribing for free below 👇

Why Time Blocking Works

Human attention and working memory are limited. When we constantly switch between deciding what to do and doing the work itself, cognitive load increases and productivity drops (1).

Planning work in advance reduces this mental load. When tasks are already scheduled, the brain no longer has to repeatedly decide what to do next, allowing more attention to be directed toward execution.

Research on implementation intentions also shows that people are far more likely to complete goals when they specify the exact time and context in which an action will occur (2).

In practice, instead of simply planning to “work on something this week”, you plan to work on a specific task at a specific time.

For people with ADHD, this structure can reduce the number of executive decisions required throughout the day.

The plan has already been made.

You simply execute the next block.

The Process

Time blocking does not need to be complicated. The goal is simply to decide in advance when your work sessions will happen and what tasks will be done during them.

Step 1: Decide your available work windows

Start by identifying the realistic work sessions available during the week.

These do not need to be scheduled obsessively or broken down into tiny increments. Instead, think in terms of focused work sessions that fit naturally into your schedule.

For example:

Monday – 10:00–11:00

Tuesday – 14:00–15:30

Wednesday – 11:00–12:00

The goal is simply to define the blocks of time where focused work is possible.

Step 2: Assign tasks to each block

Next, pull tasks from your “This Week” task list and assign them to specific time blocks.

For example:

Monday 10:00–11:00

Primary task: write article draft

Low-energy backup: create illustration

Each block should have:

• A primary task

• A backup lower-energy task

The backup task is useful on days when energy or motivation is lower than expected. Instead of abandoning the session entirely, you can switch to something easier while still making progress.

Step 3: Execute the block

Once the week is planned, the daily decision-making disappears.

No separate daily planning system is needed.

The weekly plan already defines the daily work sessions. Each morning you simply look at the schedule on your weekly overview and execute the block assigned for that time.

Many productivity systems fail because they rely on making good decisions in the moment.

Time blocking removes those decisions.

The work has already been planned.

All that remains is showing up and executing the next block.

In the next article we finish the series and look at how to improve every week with weekly reviews.

Best of luck with your time blocking,

Rich

Try the ADHD Focus & Planning System Notion template

The ADHD Focus & Planning System is designed to help you plan your week, manage tasks, and work with your energy — not against it.

Inside the system you’ll find:

• A task management database

• Time blocking functionality

• A weekly view that provides:

  • An overview of your weekly goals

  • An overview of your weekly tasks, grouped by day

  • A simple weekly review space

References

1. Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science.

2. Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist.

You sit there staring at the screen, knowing that you have all of this work to do, but not being able to start.

This is a common feeling when you have ADHD – dopamine dysregulation can make task activation feel impossible.

One of the main reasons people with ADHD struggle to start work is that goals are often too large and undefined.

When a goal exists only as a vague idea — write article, build website, finish project — the brain has to hold too many pieces of information at once: what the steps are, where to start, and how long everything will take.

This creates cognitive overload, which makes starting much harder.

Breaking goals into smaller tasks solves this problem. Instead of trying to execute a large abstract goal, you simply begin the next clear action.

This article is the third part of my ADHD execution system. In the previous articles I covered:

• How to set weekly goals

• How to manage your tasks

Now I’ll look at the bridge between the two — how to convert goals into clear, actionable tasks.

You can access the ADHD Focus & Planning System Notion template by subscribing for free below 👇

Why Breaking Goals into Tasks Works

Human working memory has limited capacity. When a task contains too many elements or unclear steps, it places a higher demand on cognitive resources and becomes harder to initiate and complete. (1)

Breaking work into smaller parts reduces cognitive load and allows the brain to focus on one manageable step at a time.

Research on implementation intentions also shows that people are far more likely to follow through on a goal when they specify the exact actions they will take, rather than simply holding a general intention. (2)

In simple terms:

Goals provide direction.

Clear tasks create execution.

The Process

Step 1: Choose the weekly goal

In the previous article we looked at how to set clear weekly goals.

For example:

Weekly goal: publish article

The goal defines the outcome you want to complete by the end of the week.

Step 2: Break the goal into tasks

Next, convert the goal into a small set of concrete actions.

Example:

Weekly goal: publish article

Tasks might be:

• Outline article

• Write draft

• Edit draft

• Create illustration

• Publish post

Each task should represent a clear action you can begin without further planning.

If a task still feels vague or intimidating, break it down further.

Example:

Instead of “Write article”

Use:

• Write introduction

• Write section one

• Write section two

• Write conclusion

The goal is to reduce the mental friction involved in starting. The level of detail required is different for everyone, so you’ll need to experiment.

When the next step is obvious, beginning becomes much easier.

Common Problems

Some issues appear frequently when people first start breaking goals into tasks:

Tasks still feel overwhelming

Break them down further until the next action is obvious.

Too many tiny tasks

Tasks should usually take around 15–60 minutes. If they take only a few minutes, group them together.

Unclear starting point

Choose the simplest or lowest-resistance task and start there.

Goals tell you where you want to go.

Tasks tell you what to do next.

When a goal feels intimidating, it usually means the next step hasn’t been defined clearly enough.

Break the goal down until the next action becomes obvious.

Then start there.

In the next article in the series we look at the next step in the system — scheduling tasks into focused work sessions using time blocking.

Best of luck with your tasks,

Rich

Try the ADHD Focus & Planning System Notion template

The ADHD Focus & Planning System is designed to help you plan your week, manage tasks, and work with your energy — not against it.

Inside the system you’ll find:

• A task management database

• Time blocking functionality

• A weekly view that provides:

  • An overview of your weekly goals

  • An overview of your weekly tasks, grouped by day

  • A simple weekly review space

References

1. Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science.

2. Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist.