Balancing Work Stress and Recovery with ADHD

Are you one of the women with ADHD who, despite lousy executive functions always seems to be appointed project manager at work? Do you go “all in” in anything from gardening to Excel filing or studies? Do you end up being involved in so many different projects, and spend all your energy joggling different balls that your weekends are all about lying on the sofa trying to recover some strength and sanity before it starts all over again Monday morning? Maybe you are one of many adult women with ADHD that already have suffered multiple episodes of burnout and know you are heading there again but just can’t stop yourself? You are not alone!

Stress can be a positive thing and many of our Letterlife ADHD-ers tell us that they need an element of stress to get shit done. But stress can also become an all-present, all-consuming toxic feeling leaving you paralyzed and burnt out. Obviously, we all experience stress at different levels and parts of our lives; it’s an inevitable part of being human. But maybe it has become such a huge part of your ADHD-life that it’s just not sustainable anymore?

A Neurodiverse life

Many of our Letterlife users testify that an ADHD-life can be a life full of joggling things that neurotypicals take for granted. And many say that, depending on their ADHD-profile and hormonal status it might be difficult to OVERVIEW everything that needs to be done, REGULATE emotions, appetite or energy, FILTER out sensory stimuli and SHIFT focus when getting distracted. These problems often result in an energy leakage every going on every minute of every day without anyone around them noticing it. They say that its often not until they close the door behind them at home, that their ADHD-brain can recharge and regroup. And it makes sense right? Because if you struggle structuring, organizing, and prioritizing everyday activities you may have to devote enormous amount of energy just to get through a regular day. Maybe you bring your work home to catch up and miss the opportunity to recover while your off work.

Therefore, neurodivergent ADHD-brains face an academic- and working life designed for neurotypical people. The risks? A mismatch between external demands and internal skills that trigger a downward spiral that, at worst, ends in total exhaustion and burnout. 

Importantly to remember, this typically has nothing to do with intelligence but everything to do with executive functions! This is why so many neurodivergent people can perform so fantastic while function so terrible!

But is it possible to break the viscous cycle and start living and working in harmony with your ADHD-brain? Is it possible to learn from our mistakes and embrace a growth mindset where challenges and setbacks are opportunities instead of disasters? We certainly believe so! Here are some simple lifehacks from our Letterlife-users letting us know that balance between work stress and recovery is an ongoing process!


When you face a big and complex task try mapping out as many of the different aspects of the task as possible on a piece of paper or a whiteboard. Be creative and overinclusive at this stage to make sure everything is in the picture before you attack the project.

Break it down!

Use your paper or whiteboard mind map to divide the project into different smaller entities. Make a timeline and try to group things that are associated in time, place, or activity into the same groups. Use different colors for different themes.


When you look at the different categories one by one are you sure that all the different parts of this project are your primary responsibility? If yes, identify the most important tasks and put them on top of your Traffic-Light-List. Draw a list with three different columns!

Column 1: Green light – Put everything you need to do today here.

Column 2: Orange light – Put all the things that could be done tomorrow or later this week here.

Column 3: Red light – Put all the things that you don’t even know if they are your responsibility and that would do good from some more time to mature here.

Let us know what you think about this blog, keep up the good work and remember to get time to recover!

/Team Letterlife

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ADHD Medication and Cardio­vascular Disease

Physicians, every time they initiate a medication treatment, are faced with the question of what possible positive and negative effects this medication may have on this specific individual, both in the short and long term. When it comes to ADHD medications, elevated heart rate and blood pressure are common side effects that are always part of the pre-treatment and ongoing assessment. This is because, if you live with a high heart rate and elevated blood pressure year after year, it can lead to heart problems over time.

However, we don’t know much about whether the quite moderate increases in heart rate and blood pressure associated with ADHD-medications have any negative health consequences in the long term. It’s been difficult to find the answers to questions like this because randomized controlled trials (RCTs) controlling for confounding and excluding chance spanning over many years are expensive, time-consuming, and difficult to perform. Prior to the study by Zheng et al in JAMA Psychiatry, one of the studies with the longest follow-up period, compared young people using ADHD medication with age-matched peers without treatment for 2 years. It showed a slight increase in blood pressure during the day but not at night. The researchers concluded that since the heart gets to rest all night, it probably recovers during that time.

Unfortunately, there are almost no studies that extend beyond 2 years, but Zhang et al follows individuals with ADHD aged 6 to 64 years for 14 years. The results show that individuals using ADHD medications had an increased risk of cardiovascular disease compared to those not using ADHD medication. The risk increased by 4% for each year the medication was used in the first 3 years before it stabilized. However, the absolute risk was low.

So, what does this mean in clinical practice? Should physicians stop prescribing ADHD medications to avoid harming their patients? And should patient refrain from using ADHD medications out of fear of developing heart problems?

No, certainly not! Firstly, it is important to weigh potential risks against proven benefits. Research shows, for example, that central stimulant ADHD medications are effective and reduce the risk of serious outcomes such as accidents, suicides, and criminal activities. Recommending people who use medication to stop based solely on potential cardiovascular risk does not take the broader picture into account. Clear recommendations require more research and studies that also include individuals over 65 years old.

In summary, we welcome well-conducted and large epidemiological studies that examine both risks and benefits of ADHD treatment in adults. Zhang and the research group behind this study are highly experienced and skilled researchers. There has been a lack of well-made research on adults and the long-term effects of medication, and this study is a significant contribution to the growing knowledge base.

However, it is also important to note that:

  1. This is an observational study where it is not certain whether there is a causal relationship and in which direction it goes. The increased risk of cardiovascular disease could also be due to other medications or lifestyle factors linked to both ADHD and cardiovascular disease. ADHD itself is strongly associated to a higher risk of cardiovascular disease based on various negative consequences of untreated ADHD.
  2. There is a long list of medications that can increase the risk of high blood pressure to a similar extent as found in this study.
  3. These results apply at the group level, and as a patient, there is no need to be overly concerned about personal health. In clinical practice, a risk-benefit assessment is always made for each individual patient, weighing the increased risk that higher blood pressure may entail against the gains that ADHD treatment can provide. Physicians regularly follow up with their ADHD patients, focusing specifically on blood pressure and other signs and symptoms of cardiovascular disease during the course of treatment.
  4. The increased risk in the study applied only to those with doses 1.5 times higher than the recommended daily dose. If you are within normal ranges, you likely have no increased risk at all.

We would like to emphasize the importance of precision when diagnosing, treating, and following up on psychiatric disorders. ADHD is no exception. We also believe it is crucial to highlight the importance of precision medicine and precision health, meaning always starting from an individual-specific risk-benefit analysis. This is especially true when it comes to individuals with ADHD, as it is such a heterogeneous group of people.

/Team Letterlife

Reference to the original study:
Zhang L, Li L, Andell P, et al. Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA Psychiatry. Published online November 22, 2023. doi:10.1001/jamapsychiatry.2023.4294

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How to Sleep Better with ADHD

Are you one of us who can snooze so many times that others wonder why you even have an alarm? And do you never feel well-rested even no matter how many hours of sleep you get? Are you someone who have always needed more sleep than others and your days have become constant yearning for the bed? Or do you use sleep as an escape mechanism to avoid having to deal with stuff you don’t know how to deal with?

Perhaps you struggle unwinding in the evenings in extra challenging periods at work? Or have you never even had routines for getting into or out of bed? Perhaps your head is full of worries that accompany you into the bedroom? The unfair paradox with ADHD is that, sleeping problems is more the rule than the exception when living with ADHD, and regardless of the cause, not getting adequate, high-quality sleep worsens existing ADHD symptoms and makes you more susceptible to stress and mistakes.

Sleep is also significantly affected by hormonal factors. During adolescence, when the risk of anxiety and depression in young women is usually at its peak, many also fall into vicious cycles of spending more and more time on screens and social media, which, in turn, eats into valuable sleep and recovery time. Also during perimenopause, sleep may change, and you may become more sensitive to alcohol, temperature, and find yourself lying wide awake entire nights without getting even a wink of sleep.

People have varying sleep needs, that is true also for neurodivergent people and people with ADHD. Perhaps you have no problem going about your daily business after only five hours of sleep? Or you feel like you shouldn’t be allowed into a meeting unless you got your solid ten hours the night before? Maybe you feel that you’ve slept enough hours but still don’t feel rested? And did you know that research show that many with ADHD do have a slightly different chronotropic rhythm? Here are some basic things to think about.

Our Letterlife-users share some of their best tips for better sleep hygiene here. Much of this you’ve probably heard before, but since sleep is so crucial for our well-being and functioning, maybe it’s worth revisiting and reflecting on once more?

Be honest!

We can’t and should try to get around that what we do during the day will affect our sleep at night. An overly busy unbalanced schedule will make it harder to unwind in the evening and conversely, being too passive may not build up the brains need to sleep. We might as well be honest about how much other lifestyle factors affect our sleep and that there might be some work to be done in other areas of life before we turn to quick fixes like medications.

Be active!

Exercise and exposure to daylight have a positive effect on sleep. It better to get the training done earlier in the day since exercising too late in the evening can make it harder to fall asleep due to the stress hormones that are released during physical activity. If the exercise is done outside so you get some daylight at the same time- win win!

Stay awake!

Even though some ADHD:ers whiteness that, a short, like  15minute nap taken not to late in the day can reboot and clear the mind, sleeping during the day will deplete your nighttime sleep needs. So, daytime sleeping, however tempting, is always a risk throwing you into a negative sleep cycle. And remember, it’s not “dangerous” to get out of bed and get through the day even if you almost didn’t get a wink last night. On the contrary, its often better to take a shitty day and hope for a better next night. Your body and brain have an amazing ability to recover lost sleep by sleeping extra effectively the following night.

So, nighty, night! Let us know what you think of these tips!

/Team Letterlife

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Exercise – Finding motivation and holding on to it

Do you have great plans and training programs that you never get around to try? Do you know that getting out on a run would be SO good for you, but you can’t get yourself out through the door? Do you struggle with finding any time for yourself at all and to ruin that exercise seems too masochistic, even for you? You are not alone! This week’s blog is about the ADHD-curse of not being able to do anything in moderation, not even exercise. But maybe you are willing to try some of the lifehacks that our Letterlife users share?

Needless to say, physical activity is good for both the body and the brain; research have consistently demonstrated this and its of course totally in line with common sense. For ADHD:ers exercise has been shown to be extra beneficial and that why it’s also extra unfair that its so extra hard to establish and maintain healthy routines when you have ADHD. Did you know that for ADHD it’s both more common to exercise too much and too little?

So, is it even worth trying? Well yes of course! Because if you manage to exercise with moderation over time, you greatly enhance your resilience to stress, get better at regulating your emotions, and reduce the risks of overall mental health and physical problems. The first good thing is that it doesn’t matter at all what type of exercise you choose. There’s no evidence that you must go to the gym, use machines, join groups, or follow any specific workout program. The most important factor is to make sure that you can follow through with your routine.

And another thing with exercise is that we tend to forget that we don’t need that much of it as we might think (or as it seems when we hear wellness gurus preach or read training blogs). The biggest threat to healthy routines may actually be setting the bar too high, going out too hard, and either getting injured or losing motivation to maintain new habits. You don’t have to go to the gym or jog if you don’t enjoy it. It’s more important to establish consistency. So, try to find reasonable and enjoyable ways to be physically active in your daily life. And KEEP IT SIMPLE! Everything counts, and the best exercise is the one that happens and that you can stick with over time. So don’t set your expectations too high, start small to improve your chances of maintaining routines over time.

Did you know that physical activity can be particularly effective during high-stress periods or when you experience anxiety? Because when you increase your heart rate and blood pressure, your brain senses that it’s “keeping the same pace the body”. In a way you can trick your brain into believing that it is running from or escaping an imaginary threat. Exercise has momentarily as well as long-lasting anxiety-reducing effects and it’s easier to think clearly and make wiser decisions after exercising. Also, both the body and the brain need to be tired to relax and fall asleep in the evening.

Let’s listen to some of our Letterlife beta users some lifehacks that has worked miracles for them. Maybe there is something in it for you as well?

Keep it close!

Always have your gym bag packed and bring it with you wherever you go. Is there anything more annoying than getting a chance to squeeze in a session and don’t have the equipment? Think like a Volvo Ocean Race Sailor and keep the bag to the bare minimum, to manage to carry it around!

Keep it simple!

Don’t overdo it. it doesn’t matter what type of exercise you do if your pulse and breathing rise a little. It’s not better to go to the gym than to take a run or a walk with your dog in the woods. Join groups if you like that or keep it to yourself if that’s how you roll.

Keep it scheduled! 

Allocate time for exercise in your schedule, in the same way that you plan for having breakfast or and engage in activities that you know have a good chance of actually happening. Morning exercise stabilizes your energy levels throughout the day and makes it easier to sleep so is it possible to fit it in early in the day?

And remember that the mistake nearly everyone makes when it comes to exercise is to focus on how awkward the actual workout will be. Try instead to imagine how you will feel AFTER your workout. In fact, it’s just that little dopamine boost that your thought provides that might get you over the hump and on your way.

Let us know what you think about this blog, and remember… Keep moving!

/Team Letterlife

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Eating with ADHD: Overcoming the Food Struggles

Do you have ADHD and find it challenging to regulate hunger and fullness, establish healthy eating routines, or deal with food-related issues? Do you eat so fast that you don’t realize that you are already full, and find yourself panting on the couch with unbuttoned jeans? Is it difficult to stop eating when something is forbidden, or do you never feel any desire for food? Or do you have an insatiable sweet tooth and a diet that gives both your dietitian and dentist gray hair?

If you’ve also struggled with eating disorders in the past, you’re probably even more sensitive to feeling uncomfortable, overweight, or unattractive in relation to food. Perhaps you’ve already noticed that these feelings become particularly intense on certain days of your menstrual cycle? Because appetite is, of course, closely connected to our hormones, and it can be more challenging to resist overeating during different hormonal phases. Also, your weight may creep up even if you haven’t eaten more than usual just because of your hormonal status during luteal phase or PMS. If you are sensitive to these experiences the post ovulatory period can trigger an exhausting cycle of starvation and overeating even if you know intellectually that your weight will drop again once your period arrives.

With this background, it’s perhaps not surprising that many individuals with ADHD have had, and still have, a complicated relationship to both food and their bodies. Indeed, research shows that up to ten percent of all individuals with ADHD struggle with full-blown eating disorders (Nazar et al., 2016). Many more are dissatisfied with their bodies and use food for comfort and emotional regulation throughout their lives. We know that the brain’s reward system and dopamine are closely linked to both ADHD and experiences of hunger, cravings, and saturation. Furthermore, sleep difficulties mor common in ADHD lead to the release of stress hormones, which, in turn, can lead to weight gain. If you’re also impulsive, a core feature of ADHD, it’s also harder to resist temptations and unhealthy foods; if you can’t regulate your energy levels, you might eat to get things going, and if you’re restless, you might eat just to have something happen.

One of the key messages in this blog is that loss of control overeating isn’t about morality, character, or stupidity. But can you have a healthy relationship with food and your body when you have ADHD? According to Letterlife beta users, you can! Here are some simple tips and life hacks that have worked well for them:

Eat Anyway!

Don’t skip meals and eat regularly even if you’re not hungry. This will help you establish routines that work over time. Always have breakfast, lunch, and dinner AND snacks in between. Both your appetite and weight fluctuations usually calm down when your body and brain start to trust that you’ll provide energy regularly. It’s also incredibly liberating to realize that you’re not thinking about food and your body every second! Don’t forget or prioritize away your meal and sleep schedule. All means are good except the bad ones, so find ways to remind and motivate yourself. Can you ask someone at home or a colleague at work to remind you when it’s time to eat? Can you plan meals together with others for support? Always have simple, healthy snacks with you!

Stop Trying to Eat Your Feelings!

Do you use food to avoid feeling sadness, shame, anger, or restlessness? Initially, you might not have the strength to stop yourself, but try just sitting with your uncomfortable feelings. Go for a run, take an ice-cold bath, or distract yourself with a TV show instead of burying your unpleasant emotions under sugar and fat. You won’t succeed every time, but more and more often if you stick to your regular eating schedule.

Create Your Own Dietry Model!

Few have missed the message that it’s good to eat plenty of fruits and vegetables, and of course, this applies when you have ADHD. However, many also find that foods rich in fat and protein, even though they contain more calories, create a more stable feeling of fullness than carbohydrate-rich foods and light products. In the end, calorie-rich food can lead to necessary weight loss in the long run and there are healthy options such as nuts, beans, avocado, egg, olive oil etc….

Keep an Eye on your ADHD Meds

If you take central stimulant medications for your ADHD, your appetite can disappear completely during the day when the medications are active. Even if you don’t feel hungry, your brain and body still need energy during the day. Otherwise, you’ll experience ADHD symptoms due to energy deficiency, despite taking ADHD medication. If you don’t eat, there’s a risk that you’ll end up in a negative spiral of consuming massive amounts of food and calories in the evening and collapse into bed. Just to repeat the same unhealthy pattern tomorrow.  Set alarms on your phone to remind you to eat. This will counteract both energy deficiency and long-term weight gain. I promise!

Enjoy your meal! /Team Letterlife

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ADHD Survival Guide for Women

If you are living as a neurodivergent woman in a world designed for neurotypical men you have probably already realized that most people aren’t wired the way you are. As a direct consequence you may also receive advice that may be entirely reasonable and relevant for most people but can be absolutely useless and, in some cases, directly harmful to you. Moreover, these well-intentioned but totally misinformed suggestions often exacerbate the frustration and self-loathing that many women with ADHD carry around.

Do you torture yourself with self-doubt and self-criticism wondering what kind of a person you are, failing people around you time after time? Who just don’t show up to a friend’s birthday party because you don’t have any energy that day? And what’s the matter with you who can’t honor a single promise or keep a single secret? Why don’t you exercise regularly, and why  eat so unhealthily when you say that you hate the way your body feels or looks? Why don’t you go to bed and get up on time? Why don’t you quit smoking, and why can’t you drink “moderately” amounts of alcohol like normal people? Do you feel that your emotions are all over the place and out of control and that you get bored when I’m around “normal” people?

You are not alone! We have heard different version of this story from many ADHD women and the people around them.

However, a crucial detail that we often overlook is that the problem, most often, is not lack of insight. In other words, it’s not that you DO NOT know that you should eat healthily, exercise regularly, manage stress appropriately, sleep well, quit smoking, preferably not consume any alcohol, and not let your emotions run wild, causing harm to yourself and others. You probably do the opposite of all this, DESPITE knowing that it creates problems.

Even more challenging, it seems for the 95% neurotypical population to understand that it’s not the facts that’s lacking, but despite having all the facts, change remains elusive. And often, I you get quite meaningless and, frankly, outrageously poor advice.

“Eating until you’re full” is, for example, not a very good idea to suggest to someone who has trouble regulating appetite and reading their body’s cues for hunger and satiety or eats due to emotional storms or restlessness. The link between ADHD, overweight, and eating disorders is indeed very strong.

“Sleep until you feel rested” is not a particularly constructive piece of advice for comforting someone with an innately disrupted chronotropic rhythm or difficulty regulating their energy levels. We know that there is a clear connection between sleep disorders and ADHD and that, due to a different reward system, people with ADHD often experience fatigue or energy depletion that cannot be alleviated by more sleep but instead requires them to activate out of otherwise paralyzing passivity.

“Let your feelings show!” Advice telling someone they must say what they think and feel, and that it’s harmful to suppress emotions, is awful advice for someone with ADHD, since research clearly demonstrate a strong link between difficulties regulating emotions, impulsive behavior, and emotionally driven actions and loneliness, divorces, work life difficulties and exclusion.

“You’ll get used to it! Trying to comfort or normalize someone’s sensory overload, social exhaustion, or perceptual sensitivity with advice like, “everyone gets a bit tired by social gatherings,” is also not particularly insightful. In the worst-case scenario, it can lead to total exhaustion, a sinking self-esteem, social withdrawal, or the development of social phobias.

But perhaps the worst advice to give to someone with ADHD is to “take a drink and relax, you only live once, and you seem so tense.” Because we know without a doubt that individuals with ADHD have a significantly increased risk of developing harmful alcohol and drug use and that we need to take special care when it comes to alcohol and drugs. This does not mean that everyone with ADHD will become substance abusers, but it does means that there is an inborn vulnerability because the same brain systems are involved in both ADHD and addiction disorders. That’s why, people with ADHD should be extra careful not using alcohol, drugs, or any other substances when they are stressed, emotional, tense or challenged in life.

Blog by Lotta Borg Skoglund MD PhD

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Life hacks for a stressed-out working mum

Lisa, one of our Letterlife Beta Users, also active in the Letterlife Coach program would like to share some insight with the rest of you. And I, as her coach, agree. Her take homes apply to so many of us who love our jobs so much that it sometimes takes over our entire lives. Lisa is surprised that her new life hacks already have positive ripple effects for her and her family.

This is her story:

I have realized for quite some time now that I needed to do some serious change in my life. And for the first time, I decided I wasn’t going to choose the easiest way that presented itself! 

Let me give you a practical example from my life: I live with my husband and our 8-year-old autistic daughter Sandra. The mornings, especially leaving our daughter at school is really challenging for all of us. I’m not sure if I have the words to describe the despair, I feel having to rush an autistic child through her morning rituals, just to leave her crying outside of school so that I can hurry home to start my workday at 08.30. I know my husband feels the same way, and that we both really struggle with doing what’s best for our daughter, at the same time fulfilling our duties at work. I have suffered several episodes of burnout in my work life already and I could feel that the symptoms were creeping up on me again. So, something needed to be done. I could not go on like this for very many more weeks…

But then I started my coaching program. The theme to work around was pretty crystal clear as you might suspect. Me and my coach discussed different ways to approach this challenge of changing our morning routines to something better for everyone in our family. We set up my individual goals, how to measure change and agreed on how my coach would hold me accountable.

And this is when the magic happened. I could have easily kept going on according to my old modus operandi (put all my energy into getting my husband to either take over the morning routines or at least argue that we devide the mornings equally between us). But I chose another way. A way where I kept control of the outcome and decided to take all the mornings. This would be tough, but it would give our daughter increased predictability and me the benefit of leaving pick up from school to my husband. Also, I dared to challenge a couple of “old inflexible truths”! Like that my workday had to start at 8 a.m. When I was able to release the time pressure that caused so much stress in our morning routine and give myself and my daughter just an extra 30 minutes, the mornings turned out quite differently. I was surprised that I “was allowed to just decide” a thing like this. And that it worked. I think I’m going to keep challenge more “truths” about other areas in life that cause stress. 

I soon realized that it’s not only stress that is infectious, but that a calm approach and attitude can be transmitted between family members as well. Previously, me and my husband used to “intrude on each other’s territories” mainly to compensate for things we were worried that the other wouldn’t do. We divide the day between us and stay out of each other’s business unless the other one explicitly asks for help. So now, my husband leaves home for work at 7 a.m. and isn’t even there for me and my daughters morning routines. Instead, he picks her up after school and I have time to exercise or just relax before the evening routine kicks in. We still see each other but we avoid the stress and irritation of rubbing each other the wrong way.

To be honest, some “side effects” that I didn’t expect emerged from this new family routine. When I was no longer responsible for the after-school pick-up I didn’t have a hard end time for my workday. The whole idea with this routine was to get some solid recovery time but now work could encroach on this without anyone noticing but myself. I’m also not entirely sure what counts as recovery for me. So, me and my coach had to go back to the whiteboard and discuss strategies to finish work and make time for recovery before the family arrives home at 5 p.m:

1. Time is of the essence! We decided that I will stop working at 3 p.m. To make sure I don’t forget I will set an alarm on my phone for 2:30. After this, I cannot start up anything new, only wrap up what I’m already working on. I make lists of what was interrupted and didn’t finish so I can pick up there the next day.

2. Border control! I have installed autoreply on my work email saying, “Hello and thank you for your email. I am currently working between 9 a.m. and 3 p.m. If your matter is urgent, mark it as URGENT! and I will make sure to prioritize it immediately when I’m back! All the best, Lisa.” 

3. Not lost in transition! To find the bridges between a workday and recovery time, I can choose between a 3-minute moving body scanning, just scrolling through Instagram for 5 minutes or do a short breathing. practice. And this is the bridge! Not the recovery!

4. Recovery of the essence! I need to explore what recovery is to me. Watching Netflix series, exercise, scrolling through social media, see a friend or read a book? Today I don’t know but my coach told me that it might be almost anything as long as it’s not illicit drugs or criminal behavior;) Oh, perhaps I forgot to mention that we use humor as a tool in our coaching sessions.

Looking back on my five-week coaching program I’d say that I feel proud of my progress. It really feels like most of the insights and change came from within me. My coach was only there as a “catalyst”. That is really empowering. And don’t worry, I’m also a very realistic and pragmatic person. I don’t expect the sky to open and to live happily ever after. But I do think that these five short sessions got me some core pieces of the puzzle that I needed to move forward on my own. And I look forward to continuing to share my progress and struggles with my neurodiverse sisters in the Letterlife community.


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Unmasking the Emotional Depth of ADHD: Exploring Rejection Sensitivity Dysphoria (RSD)

ADHD is a neurodevelopmental condition that affects millions of individuals around the world. While ADHD is often associated with symptoms like impulsivity, hyperactivity, and inattention, it encompasses a range of emotional and cognitive challenges that can be just as impactful. One of these challenges is Rejection Sensitivity Dysphoria (RSD), a concept pioneered by renowned clinical psychologist Russell A. Barkley. In this blog I will try to shed some light on this often-overlooked aspect of ADHD.

ADHD – More than meets the eye.

Females of all ages have since long known what research and clinic is starting to catch up with: that ADHD is more than distractibility and restlessness. Indeed, ADHD is a multifaceted condition that extends well beyond these well recognized symptoms. Letterlife is very much inspired by the theories displayed by Russell A. Barkley, who argue that ADHD is better understood through a framework of executive functioning deficits such as self-organizational skills, self-regulation, and emotional self-control.

Since ADHD can manifest so differently in everyone, a spectrum of symptoms can be the outcome of the same underlying disorder. For some, ADHD is manifested predominantly as inattention, causing difficulties in sustaining focus and completing tasks. For others, hyperactivity and impulsivity take the forefront, leading to difficulties in risk-taking behaviors and problems in social interactions.

Rejection Sensitivity Dysphoria (RSD)

Among the many challenges associated with ADHD, Rejection Sensitivity Dysphoria (RSD) stands out among girls and women. The term RSD, coined by Barkley several years ago, describes how children and adults with ADHD experience intense emotional reactions when feeling criticized, get negative attention or feel left out in social situations. It’s not a formal diagnosis but rather a concept very accurately describing the heightened emotional responses displayed by many children and adults with ADHD when they feel questioned or rejected by their peers.

Of course, RSD is not unique to ADHD, but according to Dr Barkley it seems to be particularly common in neurodivergent people of all ages. Individuals suffering from RSD often find themselves overwhelmed or almost “kidnapped” by emotions of loneliness, hurt, sadness, frustration, or anger in response to perceived criticism or rejection, even if it’s totally and honestly unintentional or perceived as a “silly thing” by others. Others may feel that these strong emotional reactions are quite disproportionate to the situations. Thus, extremely unfortunate for neurodivergent people with RSD, they distance themselves or withdraw from the person with RSD, making the self-full fulfilling prophesy a fact.

How is ADHD and RSD associated?

So, how does Dr Barkley explain the connection between ADHD and RSD? Well, much of Dr Barkley’s work emphasize that individuals with ADHD often have deficits in emotional self-regulation. These deficits can result in heightened emotional responses to criticism or rejection, leading to RSD. Moreover, the challenges in executive functioning can also contribute to misunderstandings, impulsive reactions, and difficulties in social interactions, further fueling the emotional turmoil. Adding female hormonal fluctuation to the mix usually doesn’t help.  Rather naturally cycling girls and women with ADHD and RSD, daily life can be a rollercoaster of intense emotions, misunderstandings, strained relationships and sinking self-esteem.

Is there anything to be done?

Yes of course, and just as with so much around ADHD and mental health it starts with self-awareness and understanding that RSD is a real and valid aspect of ADHD. And, importantly, that you are absolutely not alone having these experiences. Also, Cognitive Behavioral Therapy (CBT) can offer valuable tool for addressing RSD by identifying and reframing irrational thoughts about what others may think and how to interpret others’ behaviors. By questioning what you perceive as criticism or rejection, you can take control over your emotional responses and reduce the intensity of your emotional reactions. Many girls and women find support networks like our Letterlife Community crucial to gain control over their RSD. By sharing your experiences with others that truly understand what you are experiencing. Many of our users say how much the testimonies of community members have helped them gain a deeper self-awareness and articulating feelings and experiences in words that makes sense for their friends and family members. The beauty of the LL Community is that it’s there for you 24:7 offering understanding, empathy, and guidance during challenging times.

So, to conclude, it’s essential to remember that ADHD so much more than inattention and hyperactivity. Females with ADHD face complex challenges affecting emotional, mental, and physical well-being. By embracing the important work by Dr Russell Barkley, we can all be part of the movement towards a more inclusive and empathetic society, ensuring that females with ADHD and RSD receive the understanding and support they deserve.

Do you want to be part of a more compassionate and supportive environment for girls and women facing the same challenges as you? 

Do you want to raise awareness about RSD, reduce stigma and help others find the resources and support they need? 

Then you should join our new avenues for research and support by co-creating Letterlife Community with us!

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The story of aging with ADHD

By Heidi Dellafera Eagleton, AA, BA, JD, MArch

It’s time to consider aging adults, who, like me, were diagnosed with ADHD (attention deficit hyperactivity disorder) in their sixties or later, or those elderly adults who have never been diagnosed. For years, professionals regarded ADHD as a “childhood disorder primarily affecting young boys.”

Although research and diagnosis of adults with ADHD have increased over the past twenty years, it has not been the case for older adults. Of people over sixty-five who live with ADHD, an estimated 2-3 percent, only 0.2-0.5 percent of these individuals have received a formal diagnosis, and therefore have had to struggle throughout their lives without a correct explanation or the tools to manage ADHD’s challenges.

I was diagnosed. I was one of the lucky ones.

I now can question as givens commonly accepted and internalized ageist stereotypes, or the evidence of cognitive decline, or the beginnings of dementia among seniors, “inattention, difficulty concentrating, poor listening skills and impulsivity.” For aging adults, like me, these are ADHD challenges that have been with us, diagnosed or undiagnosed, for almost a lifetime. They are not necessarily a part of the “normal” aging process, as is often thought. Few ask if these stereotypical behaviors are something else. I think it’s time that we do.

Looking Back

That I’m writing this now is astonishing, having lived with undiagnosed ADHD for the better part of my lifetime. In grammar school, I could have been the poster child for ADHD had it been thought of as an “affliction” for young girls as well as young boys. But it wasn’t, and it would be years later before girls, let alone a woman in her sixties, would be diagnosed. And it would be years before that woman finally would believe that she wasn’t “stupid” or “less than.”

For years before I was diagnosed with ADHD, I fought self-doubt. The seeds had been planted in 1966 by my high school guidance counselors who said that based on my entrance exam scores (SATs), that college was out of my reach and capability.

My dad, my biggest fan, would have none of it. He told me to dig deep inside myself, to avoid doubters, and, by tweaking a famous quote by Theodore Roosevelt, to “reach for the stars but to keep one toe on the ground.” Everyone needs a “biggest fan” like that.

He said that if I worked hard and kept my head on straight, I could be whatever I wanted to be regardless of what others thought, even those “in the know,” or those who laughed at my ambition, which at the time was to become a trial lawyer.

By working harder than most, I shined academically except in math, my nemesis. Yet despite my good grades, I struggled with standardized tests. I never met one I liked or had success with, whether it was an SAT, LSAT (law school entrance exam), or a state law or architectural licensing exam. I knew a lot, but it wasn’t evident in my test scores no matter how hard I tried or how hard I prepared for tests.

Somehow along the way, though, I learned to refuse to take “no” for an answer. It was a skill that would serve me well. If the front door was closed, I went through the back door, side door, or basement door. And often the front door was locked as well as closed.

Proving my guidance counselors wrong, I graduated with an Associate of Arts (A.A.) degree in 1968 from my “safety school,” a junior college, which at the time was considered one step above a “finishing school.” It was a detour I had to take due to my lousy SAT scores. Later, in 1970, I graduated with a Bachelor of Arts (B.A.) degree with departmental honors in government from the all-women’s, four-year college I had wanted to go to straight out of high school.

Law school was next. Not surprisingly, my LSAT scores were dismal, 326 out of a possible 800. Suspecting that my scores might be a problem, I visited the law school I wanted to attend to ask that they be waived and that I be accepted based on my academic record. Before the admissions committee, I argued that I was a great student, just a lousy standardized test taker with a history of standardized test failures to prove it. I won my first case.

Three years later in 1973, I graduated with a law degree (J.D.), one of about seventy-five women out of a class of around 750 students, and by mid-1974, I was on my way to fulfilling my high school dream of a career in trial law. That same year I passed the bar exam after being tutored on the “art of taking standardized exams,” which I learned had more to do with methodology than with actual knowledge.

I had reached for the stars with barely one toe on the ground, and at the same time had conquered at least one pesky “multiple-choice” exam. To hedge my bets, I took two different state bar exams over the course of three days. Amtrak helped with that. I passed both, thanks to my tutor and a little ceramic elephant he had given me to put on my exam table for good luck.

Nonetheless, I found it difficult to manage the everyday job of living in the moment. My drug of choice was work; chocolate was a close second. I was a workaholic who looked forward to spending Friday nights alone reading legal cases while devouring half of a chocolate cake to numb my pain and ease my anxiety.

I made little time to do much outside of the law or eat on a regular basis. I weighed 107 pounds soaking wet at five feet four inches tall, fifteen pounds less than I weighed when I started law school. I smoked like a chimney. Coffee, and plenty of it, helped me focus. Ritalin wasn’t on my radar then. I pushed on. I had to be the best trial lawyer I could be.

My anxiety about being “stupid” drove me to work harder and longer than was necessary and sleep less than what I needed. I became a classic overachiever. I juggled multiple balls in the air with abandon. Few could keep up with me, my energy, or my hyper-focusing. Few wanted to. Many of my relationships suffered. Moderation wasn’t a part of my vocabulary.

But then the unexpected happened. It always does. Life got in the way. After I married in 1976 and shortly after my dad’s death in 1977, I became pregnant. That wasn’t part of the plan so early in my legal career. It wasn’t even on the map in high school when I chose my future career path. Nor was the loss of my dad, my “anchor” and my “sounding board.” I quit smoking the day I found out I was expecting.

I liked the law. I had worked hard, and I was on partnership track at my law firm. But the firm’s billable hour expectations with a new baby seemed beyond my reach at the time. My lack of confidence led me to believe that I needed a course change so I reluctantly left the law in 1978. I couldn’t cut it, I thought. But I wanted a career, and if it wasn’t law, it had to be something else. I still had to prove myself to me and to all those who had doubted me.

That something else would be architecture, an interest I had developed while I was renovating our 1850s farmhouse, which my husband and I had bought shortly after we married. Naively, I expected architecture to be more compatible with family life than trial law.

I was wrong. Architecture was just a different kind of pressure, with more years of schooling and a husband and now two children. I struggled to keep up. After a few fits and starts, I finally received my Master of Architecture in 1986.

Like law, architecture required enormous commitment. I spent many “all-nighters” in the design studio, after putting my children in bed, cranking out designs and building models. I had never pulled a law school “all-nighter.”

I was known by fellow architecture students, all much younger than me, for my habits as well as my design skills. I was that “older student” who drank “Tab,” a diet cola filled with caffeine and discontinued in 2020, and who ate sugar-coated “Frosted Flakes” by the handful during design reviews depending on its “sugar high” to keep me from “nodding off” during critiques. Little did I know at the time that both were effective ways to help me stay focused.

I also was known as that “older student” with the two kids in tow. It was clear from the outset that my children and I were a package deal, an anomaly for college students in the mid-1980s. My youngest son came to the studio with me. I set up his playpen under my drafting table, one of two mothers who did. My older son wasn’t far off. I could see and hear him on the playground at a small private school across the street from the architecture building. Lots of faculty sent their kids there, but I was the only student who took advantage of that opportunity, and I was probably only one of the few students who needed to do so.

Sometimes, in my more “sober” less frantic moments, I questioned what I was doing. In my heart I had accepted that I was different, and more importantly that I thought differently. My life to date had left no doubt about that. But what I had accepted in my heart didn’t matter. I had to appear to “fit in” and appear on the outside, the side everyone would see, to be an architect’s architect.

I spent the better part of ten years trying to pass all six sections of the Missouri architectural licensing exam to be able to call myself an “architect,” hang up my shingle, and start my own practice. Eventually, after finishing my three-year internship, a requirement to sit for the exam, and after having to start the exam all over because of a move to a different state, I would pass its six sections. But I hadn’t passed them in the right sequence all at the same time, another but more curious requirement, for credit and a license. My self-esteem took a big hit.

The scars had grown deeper. My “stupid” and “less than” meter was off the charts. The architectural licensing exam was to be one of the last standardized tests I would ever take. I felt like a total failure.

After many therapy sessions in my sixties, many tears, and an ADHD diagnosis, I became convinced that the time I had spent chasing the architectural licensing exam was time not well spent. I understood that the chase had been driven entirely by my relentless anxiety, like so much of my life before had been driven, over being thought “stupid ” and “less than” and my unstoppable need to prove it wasn’t so. I had to “fit” in.

I’m grateful that I didn’t have to pay the ultimate price, estrangement from that which brings me my greatest joy, my family. During the years I was on the chase, I almost lost the very thing I wanted most, a healthy balance between my career and my family life. By the time I finally understood this, my two sons had graduated college and had become awesome young men.

During those same years, though, my career suffered little; it flourished. In 1989, I started my own architectural firm, partnering with one of my architecture school professors, a licensed architect. In 2004, I folded our architectural firm into a combined practice; development, architecture, construction, and real estate sales, and for over fifteen years, I was its owner and president. I also was an Adjunct Professor of Architecture at a Historically Black College and University (HBCU), and a guest lecturer at several colleges and universities with SAT standards so high that, ironically, I wouldn’t have had a prayer of being accepted to a first-year class there when I graduated from high school. Not bad for a “girl” who wasn’t college material.

Looking Forward

A much-needed wake-up call, a fall Christmas Eve morning in 2022, resulting in a severed right rotator cuff and a busted-up bicep, made me realize that my life aging with ADHD needed tweaking. While I was stewing about how I would get everything done, I slipped on an ice patch behind the garage apartment my husband and I were renting while visiting our family for Christmas.

With the bucket of Christmas greens, I was carrying still intact in my left arm, I hit the ground, saving most of its water from spilling out. But my right arm hadn’t fared as well. It was splayed out in front of me in the alleyway like a filleted fish ready for the frying pan.

I’d lost my focus that Christmas Eve day. I wasn’t watching where I was going, thinking about a million things, including our “Feast of the Seven Fishes,” Christmas Eve dinner, a family tradition, later that evening.

That I had been inattentive in the past and gotten away with it unscathed didn’t matter. This time, to make matters worse, it happened on a special occasion, Christmas Eve day, the day my family would celebrate the “Feast of the Seven Fishes” as all good Italian families do. What horrible timing.

Lying in the middle of the alley with my right shoulder throbbing in pain that morning, I knew then that I had to be more mindful, discerning, attentive, and less impulsive. I knew I had to slow down and focus on one task at a time. I knew I had to learn that I still could do multiple things, just not all at once. And even after my ADHD diagnosis and years of counseling, I knew that morning that I had more about my ADHD to understand and, most importantly, to accept.

Going forward, my job is to age successfully with ADHD by using the tools I acquired after my diagnosis and by embracing ADHD’s positives: “creativity, tenacity, boundless energy, curiosity, and the ability to hyperfocus and to think outside of the box,” and to negotiate its challenges: “inattention, difficulty concentrating, poor listening skills, and impulsivity.” Not an easy task, but a necessary one.

In retrospect, I believe that I navigated my life’s journey and the bumps along the way because I unwittingly used my differences and my ability to “think outside of the box” to carry on successfully despite my high school guidance counselors’ dire predictions. Going to a junior college, my law school admissions visit, hiring a tutor to teach me the “art of taking standardized tests,” hedging my bets by taking two state law exams at once, bringing my kids to architecture school with me, and partnering with a licensed architect and one of my architecture school professors to start an architectural practice are all evidence of that.

However, at the same time, I also believe in retrospect that my ADHD challenges: “impulsivity, perfectionism, my tendency to make careless mistakes, and my inability to moderate,” went into overdrive unchecked and left me feeling “stupid” and “less than.” I had stayed in the “I have to prove that I’m not stupid” game way too long.

Today, I look at my ADHD not as a “disorder” or “deficit,” or negatively, but as a “difference,” an attention and/or hyperactivity difference with positives to be harnessed, and challenges to be addressed. From the front seat, I think it’s time to focus on what’s working and draw from it.

My ADHD and I will always be a work in progress. I’m not a journalist or a mental-health professional. I can only tell you of my personal experiences living with and aging with ADHD, both diagnosed and undiagnosed. But I can say that passion, a sense of humor, and the courage to change course in the face of fear and do it anyway help. Flexibility doesn’t hurt either. I still do a million things, just not all at once. I am who I am.

My husband and I recently sold our home, downsized, and moved across the country with our dog, Maddie, to settle into a 1,200 square foot floating home on Lake Union in Seattle, Washington. I changed careers, closed my development, architecture, and construction company to write children’s chapter books, a long-time passion, to keep me focused. Every evening, I try to sit quietly on our roof deck to watch the sun set over the Lake Union and with the Olympic Mountains in the background practice mindfulness. For all of this, I am grateful.

To harness my boundless energy, I Zumba three times weekly. It’s an aerobic fitness program, which I started in my sixties, “featuring movements inspired by Latin dance and performed mostly to Latin music.”

I no longer run. I take long walks with Maddie daily and kayak as often as I can. I now hike with poles, and I’ll probably give up skiing and give snowshoeing a try due to my shoulder injury.

And above all, as a senior about to turn seventy-five, I have chosen to embrace even more tightly the differences that made me, me, to find joy, and to live life to its fullest while aging with ADHD.

Awareness, research, knowledge, and diagnosis are powerful weapons that can advance positive ADHD outcomes. Without these weapons, the tools needed to meet its challenges and to harness its positives are difficult to come by. Anecdotally, I’m proof of that.

So, for those of us out there aging with ADHD trying to flourish in a society that tends to favor “youth over experience,” remember us. We must be included in the dialogue and not be forgotten by the ADHD community. We need many more “lucky ones.”


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Sleep and ADHD – A Well-Known Balancing Act

Unfortunately, having sleep problems is the rule rather than the exception when living with ADHD (Wynchank et al., 2017). Perhaps you are one of those who find it difficult to unwind in the evenings, with thoughts constantly swirling around and around? Maybe you’ve never been able to establish sleep routines, or your inner restlessness simply prevents your body from relaxing enough to fall asleep. Some consume too much coffee or energy drinks too late in the day. Others are plagued by anxiety and rumination. And how fair is it that when you finally get into the flow of what you’re working on, you have to go to bed? Many with ADHD also report having shallow and fragile sleep, where the slightest noise or light can disrupt their much-needed rest. Regardless of the cause, it’s not great for the brain to miss out on proper quality sleep. Sleep deprivation often exacerbates existing ADHD symptoms (Floros et al., 2021 ), and daytime fatigue makes one even more vulnerable and sensitive to stress.

During periods of poor mental well-being, it can also be challenging to go to bed on time, unwind to fall asleep, or get up in the morning. As we have written in previous blogs , coexisting mental health conditions are much more common among both adults and children with ADHD compared to those without. Some experience restless and fitful sleep, while others use sleep as an escape or a way to avoid tackling overwhelming or anxiety-inducing tasks. Sleep is also clearly affected by hormonal factors, and during adolescence, when the risk of anxiety and depression in young women tends to be highest, many fall into vicious cycles of spending more and more time on screens and social media, which in turn takes away valuable sleep and recovery time. Even during perimenopause, sleep patterns can change, and some may become more sensitive to alcohol, room temperature, and occasionally find themselves wide awake the whole night without getting a wink of sleep.

But people have very different sleep needs. Perhaps you’re one of those who can get by on five hours of sleep? Or maybe you don’t feel like yourself if you don’t get your solid ten hours per night? Perhaps you sleep enough hours, but you never feel truly rested?

Here are some concrete and practical sleep hygiene tips from our Letterlife beta users. You’ve likely heard much of this before, and maybe you feel like you’ve already tried everything. But since sleep is so crucial for our well-being and functioning, it might be worth checking off all the tips on the list once more. Here’s what our users consider most important for achieving quality sleep despite ADHD:

  1. Be physically active outdoors and in daylight during the day, as even short periods of light and fresh air are good for sleep.
  2. Establish sleep routines and stick to them even if life around you change. If possible, go to bed and wake up at approximately the same time every day.
  3. Create an evening routine that you find cozy and soothing to wind down about an hour before bedtime. Dim the lights and take a warm shower, as the temperature change (your “core” temperature decreases while skin temperature increases) mimics what happens when we’re about to sleep.
  4. Avoid working or doing anything that “stimulates the brain,” such as checking emails, online shopping, or engaging in social media.
  5. Try sleeping with a weighted blanket. It can make it easier to relax and fall asleep.
  6. DO NOT nap during the day, no matter how rough your night was or how tired you are! If you must nap, never sleep for more than a power nap of 15 to 20 minutes.

If you want to read more about ADHD and sleep and get more tips, check out the book “ADHD Girls to Women- Getting on the Radar” and join Letterlife!

Sleep Tight!

/Team Letterife

  1. Wynchank D, Bijlenga D, Beekman AT, Kooij JJS, Penninx BW. Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature. Curr Psychiatry Rep. 2017 Oct 30;19(12):98. doi: 10.1007/s11920-017-0860-0. PMID: 29086065.
  2. Floros O, Axelsson J, Almeida R, et al. Vulnerability in executive functions to sleep deprivation is predicted by subclinical attention-deficit/hyperactivity disorder symptoms. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6(3):290-8.

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