ADHD Fatigue: Understanding The Link

Living with a neurodevelopmental disorder like ADHD (attention-deficit/hyperactivity disorder) in a neurotypical world can come with many challenges. Activities like getting ready in the morning, juggling work or school deadlines, and managing everyday responsibilities can seem overwhelming. Social activities for people with ADHD can be stressful, too. One may fear speaking impulsively or missing important social cues. The lingering stigma around the disorder, which can result in a lack of understanding and empathy, can contribute to additional difficulties. 

Trans-diagnostic approach studies repeatedly show that fatigue tends to be closely associated with ADHD. However, various strategies can help people with ADHD manage fatigue and cultivate more balanced energy levels. Using time management tools, maintaining a structured routine, getting adequate sleep, and getting plenty of exercise can be helpful. For more individualized insight and guidance, consider working with a licensed therapist in your local area or through an online therapy platform.

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Fatigue related to attention-deficit/hyperactivity disorder (ADHD): causes and contributors

The relationship between fatigue and ADHD is often complex and multifaceted because it may be difficult to tell the difference between the factors that can cause the disorder and the factors that may contribute to pre-existing fatigue. In most cases, the relationship is a bi-directional combination of internal and external conditions. 

Here are some factors potentially associated with ADHD fatigue:

• Central fatigue syndrome (CFS) and chronic fatigue syndrome: These neurological disorders usually affect the nervous system, impacting focus and attention. Though the connection with ADHD still isn't fully understood, studies indicate they can be closely linked with ADHD symptoms. 
• Hypermobile Ehlers-Danlos syndrome (hEDS): While conditions like hEDS and other hypermobility spectrum disorders typically cause sleep problems and fatigue, research suggests that individuals with hEDS and co-occurrent ADHD may experience higher levels of fatigue and sleep problems. 
• Cognitive fatigue: Individuals with ADHD may experience mental exhaustion or cognitive fatigue resulting from the constant effort required to focus and regulate attention in various situations throughout the day. 
• Executive functioning challenges: Difficulties with executive functioning capacities like planning, organizing, and following directions can contribute to ADHD fatigue.
• Overstimulation: People with ADHD are often more sensitive to external stimuli like sound and touch. The bombardment of sensory input can be overwhelming and draining.
• Emotional exhaustion: Managing the emotional aspects of ADHD, like frustration, impatience, and stress, can be taxing on one's energy. 
• Sleep dysfunction: Some individuals with ADHD are at a higher risk for disorders like sleep apnea and restless legs syndrome (RLS).
• Stimulant medications: Many medications used to treat ADHD are classified as stimulants, with sleeplessness as one of the most prominent side effects.
• Comorbid disorders: ADHD often co-occurs with other mental health conditions like anxiety, which, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), often features symptoms like fatigue and sleep disruptions. 
• Hyperfocus: Individuals with ADHD may experience an intense, prolonged fixation on an activity or interest, often referred to as hyperfocus. This symptom can create burnout fatigue for adults with ADHD at work or for children and young adults at school. 

How to manage ADHD fatigue, its symptoms, and its contributing factors

It may take time and patience, but it can be possible to reduce ADHD fatigue and manage its contributing factors. Here are some tips: 

Use organizational and time management tools

Relying on tools like timers and calendars throughout the day can relieve some of the mental pressure to keep track of your tasks and budget your time, potentially reducing stress and fatigue.

Keep a structured routine

Sticking to a daily routine can alleviate fatigue caused by extra energy expenditure. This can include creating a loose schedule for the mornings, work or school, and afternoon activities, allowing for plenty of time to wind down before bed. Prioritize your tasks for the day and break the larger ones up into smaller pieces to avoid racing thoughts or impulsive symptoms that might interfere. 

Post your schedule somewhere visible, and don't forget to set timers to keep you on track. A good practice may be to schedule the most energy-consuming tasks earlier in the day, so that by the time you're winding down, there's not as much left to potentially distract you from your sleep routine.

Take regular breaks

Whenever possible, try to schedule small breaks throughout the day when you've noticed your energy begins to wane (not when you're ready to crash). You can spend this time engaged in some light stretching or energetic breathing exercises. Quiet activities like journaling can help you focus and relax all at once.  

Try to get adequate sleep to avoid ADHD fatigue

Sleep deprivation tends to be one of the most significant contributors to daytime fatigue. It may seem like a big undertaking, but try to take care of your sleep hygiene and prepare for a good night's sleep every night. Set your alarm to go to bed and wake up at the same time every day, create a cool, dark environment conducive to solid sleep, and wipe your schedule clean until the next day. 

Practice stress management techniques for attention deficit/hyperactivity disorder

The body's reaction to stress can initially be invigorating, but you'll likely feel drained and exhausted after your "fight-or-flight" response has subsided. Stress management methods, such as mindful exercises and breathing, can help you stay grounded in the moment and neutralize the stress response. It may also help to physically remove yourself from the environment for a moment (if possible) to avoid becoming overwhelmed. Take a quick walk outside, or even excuse yourself and step into the bathroom for a moment to regroup before returning. 

Manage any attention-deficit/hyperactivity disorder (ADHD) medications

Stimulant medications are typically among the most common methods for treating ADHD. While they're often effective, these types of medications can also sap your energy and disrupt your sleep schedule. Consult your doctor with any concerns about your body's response to your medication.  

Make nutrient-dense eating choices

Eating habits focused on nutrient-rich foods can be essential to overall well-being, and they can also significantly impact your energy levels. Many people choose to avoid sugar, caffeine, and alcohol because, while they may contribute to a temporary spike in energy, the crash that comes after can drain your energy for the rest of the day. 

Get plenty of exercise

Research shows that exercise can produce energy at the cellular level by increasing mitochondrial production, boosting oxygen circulation, and increasing hormone levels. This type of sustained energy can stave off chronic fatigue and regulate healthy sleep patterns. 

Pay attention to your body and practice self-compassion with ADHD symptoms

Engaging in energy-boosting activities can be effective for combating ADHD fatigue, but these activities may not be as effective if you don't pay close attention to your body's signals. For example, a journaling session may clear out "brain fog," but exercise can reduce mental fatigue and energize the body.

Seeking professional guidance for attention deficit/hyperactivity disorder

Chronic exhaustion and fatigue can have several causes, so consider visiting your general practitioner for a thorough check-up to rule out any severe medical conditions. Once you've addressed potential physiological causes, understanding ADHD fatigue can be the next step toward overcoming it. 

Incorporating a holistic approach that combines lifestyle adjustments and coping strategies can be effective, but guidance from a therapist may be essential for learning how to manage ADHD. For many, online therapy may be the most convenient and effective way to handle the disorder.

How can online therapy support the mental health of people with ADHD symptoms and ADHD-related fatigue?

Online therapy can be more advantageous than traditional therapy for people with ADHD-related fatigue in several ways. For example, it generally allows individuals to attend sessions from the comfort of their own homes with flexible scheduling options, potentially reducing the stress and fatigue associated with time management and organization struggles. In the same way, online therapy typically enables professionals to use online tools to monitor their clients’ progress remotely, provide ongoing support, and offer strategies for managing fatigue between sessions. 

Effectiveness of online therapy for adults with ADHD

Online ADHD therapy is often more affordable than conventional therapy without insurance, and an abundant body of research shows it can be more advantageous in some instances. For example, one 2022 meta-analysis and systematic review found that remote intervention usually had high treatment adherence rates for adults with ADHD, and many participants reported better attention and social function after virtual sessions.