When Stress and Anxiety Endure Too Long: ADHD Brains Seizing Up, Toppling Down
What are the signs of anxiety and stress lingering too long in an ADHD brain? As social distancing stretches into its fourth month, ADDitude readers are reporting high levels of exhaustion, frustration, and anger as the lack of a stable routine begins to take a new toll. The results of our latest survey show persistent challenges with diet, sleep, exercise, and treatment for some.
June 1, 2020
Imagine that your ADHD life is a massive, teetering Jenga tower. The structural blocks at the base generally fall into one of three categories:
- Requirements, or To-Dos
- Repercussions or Accountability
Stacked atop this foundation are the blocks that comprise a healthy life: relationships, diet, exercise, mindfulness, sleep, and ADHD treatment, to name a few. At the very top is your productivity, happiness, and sense of purpose.
When life went into lockdown about 12 weeks ago, it was as if someone hastily yanked out blocks from the base of your Jenga tower. Suddenly, your child’s morning routine was missing. Gone were the many carefully laid blocks of your calendar — the doctor’s appointments, the birthday parties, the travel plans. Your foundation was hollow in places, but it stood — for a time.
As this pandemic has worn on, new holes have opened up in the tiers above. You are telling ADDitude that you aren’t sleeping well at night but taking naps during the day due to unexplainable exhaustion. You are making home-cooked meals, but also snacking too much and self-medicating with alcohol. You should start a new exercise routine now that the gym is closed but just can’t summon the motivation to work out alone. Sometimes, removing one health block causes two or three others to just fall out. It’s as if they need one another for stability.
Your Jenga stack has been swaying for weeks. According to the results of ADDitude’s latest survey of 1,521 readers, many towers are now beginning to fall, brought down by one too many fundamental changes. Summer camp was canceled. Work has resumed in-office operations. Your state has opened up despite continued COVID diagnoses. The news is terrifying in new ways. Whatever the cause, more pieces of your routine, requirements, or repercussions have been knocked loose, and they’ve caused the whole precarious stack to come crashing down.
“I have learned how much I thrive on a schedule; quarantine took that schedule away,” said a young woman with ADHD and anxiety. “I have also learned that if I don’t have specific goals set in place, it is really easy to be unproductive, and how important it is for me to catch myself in the middle of being unmotivated and procrastinating, and take a minute to re-evaluate and re-center my perspective. I have found that I can often let my brain just take me on a non-motivated, lazy, downward spiral if I don’t make an effort to recognize and stop it.”
“I have learned how important the role of structure and routine has been for me,” wrote one woman with ADHD, anxiety, and depression. “Knowing it’s a coping tool is one thing but having a stark comparison between a way of life with routine and structure, and one without (in a short span like the light switch on and then suddenly the power line is cut) really opened my eyes. The increase in anxiety and subsequent emotional roller coaster has been hard.”
Indeed, 60% of the people who responded to ADDitude’s May 18 survey reported feeling anxious, overwhelmed, exhausted, and/or worried — only a slight drop from the 68% who first reported feeling that way in early April. Seven weeks is a long time to hold all of that anxiety inside.
When we experience stress, the sympathetic nervous system is activated, and our fight or flight response is triggered, according to Michelle Frank, Psy.D. We feel anxious, reactive, irritable, and threatened. “When we spend more time in this heightened state and can’t seem to escape our stressors, as is happening now, we go into overwhelm — this is when we enter the zone of hypoarousal, or the ‘dorsal vagal freeze state,’” said Frank in her recent ADDitude webinar on the topic. “We can look at this zone as a protective path of last resort. We become numb, we feel disassociated, and are unable to act. We effectively shut down.”
“I can’t get things done, even with all the time in the world,” wrote one parent of two teenagers who says she feeling anxious.
Shutting down — or tumbling down, as the case may be — looks different for every person, but one trend did appear throughout the survey results: The adults with ADHD who were able to assemble new routines and build new habits early in the quarantine report better physical, mental, and emotional health.
ADHD Diet: New Habits in Quarantine
Overall, 24% of survey respondents said they are eating more healthy now than they were before stay-at-home orders began. Without the temptation to eat out at restaurants, pop in for drive-thru food, or run out for snacks, these ADDitude readers say they are cooking more and eating more fresh, unprocessed foods.
“I have more time to prepare healthier meals,” wrote one mother with ADHD and autism. “I don’t go into town often, since I’m working from home, so the temptation for fast food isn’t there.”
“As a working mother and wife, for the first time in my adulthood I am not stressed to the gills over not having the time or energy to give my family the best of me. I can now,” wrote one mother of two who is working 7 days a week now. “I feel so selfish, but I have loved being able to cook more homemade meals rather than being rushed by schedules and ordering take out all the time. I love to cook but struggled pre-COVID with meal planning. This hasn’t been an issue during the pandemic.”
Several ADDitude readers reported that less frequent grocery trips have forced them to be more organized in meal planning, and that this new structure has actually made cooking less stressful. “I am in charge of shopping and cooking, and I have been way more organized and successful with that than in the past,” wrote one middle-aged woman with ADHD, anxiety, and depression. “In the past, I did grocery shopping three times a week so that it didn’t get overwhelming. Now I try to go only once a week and get in and out fast. I plan a week’s worth of meals including breakfast, lunch, and dinner. We are eating healthier… and spending less money because we almost never get take-out.”
The Relationship Between ADHD Diet, Exercise, Sleep, and Treatment
The ADDitude survey respondents who reported eating healthier in quarantine were also significantly more likely to report better sleep, more exercise, regular mindfulness, and more consistent ADHD treatment than those who are eating about the same or worse than before. Among those eating a healthier ADHD diet now, 47.7% also said they are sleeping more now, compared to 37.9% of the full survey audience. Similarly, 43.4% of healthy eaters said they are exercising more now, compared to 28.5% of the full audience, and 45% said they are practicing mindful meditation more than before, compared to 33%.
Sadly, the reverse is also true: ADDitude readers who are eating worse now are also more likely to report sleeping and exercising less, and treating their ADHD symptoms less consistently. Among the 26.57% of survey respondents who said they are eating a less healthy diet now, 63% also said they are exercising less than before, compared to 45% of the all readers. Similarly, 34% also said they are sleeping less than before, compared to 24.7% of all readers. And 28% said their treatment has grown less consistent in quarantine, compared to 21% overall.
Of course, these trends do not prove causality; we can’t show that eating a poor diet causes a person to exercise or sleep less. But it does suggest an interrelationship between the many blocks that stack atop one another to make a healthy lifestyle. When one block is jiggled out of place, the others around it shift and fall away as well.
Diet may reflect any number of external factors not measured in our survey: income, availability of fresh foods, pre-existing conditions, employment status, and overall mental health. Many survey respondents, for example, reported self-medicating their anxiety with food and alcohol.
“I have been using food and (some) alcohol as coping mechanisms and rewards, even though I know it’s not healthy,” wrote one woman with ADHD and dyspraxia.
“Convenience foods and snacks are so much more accessible when you’re at home and feel stressed out about life,” wrote one reader with ADHD in Sweden. “In my usual routine, I had to plan my daily meals, leading to healthier eating.”
ADHD Exercise Habits in Quarantine
As with food, upended routines have pushed 45.7% of ADDitude readers into worse exercise habits than they had before the pandemic. When gyms closed, they took with them the accountability and peer pressure that motivated many survey respondents to exercise regularly. Swimmers can’t get in their laps, and that pilates class just isn’t the same online. Also, kids who got regular exercise on the playground and during P.E. class are missing those physical outlets and unexcited about replacing them with solo activities or yet another game of tag with siblings.
“I used to do yoga every day and walk a lot, but in the past month I have just been sleeping, sitting and reading, trying to remember what I was doing, and then sleeping some more,” wrote one ADDitude reader with ADHD and PTSD.
“I went from being active 3 to 5 times a week with weight training and yoga to barely being able to motivate myself to work out once,” wrote one woman who says decreased physical activity is impacting her sleep. “The reason is mainly that I would perform these activities in other spaces: the gym for weights, and a studio for yoga. Trying to live, work, and exercise all in the same room for 8 weeks has been so challenging.”
Among the 28.5% of ADDitude readers who say they are exercising more now, most say they are walking a lot, have discovered YouTube workout videos, or are taking up running or biking.
“I have made it a priority to exercise daily in order to keep my mood stable,” wrote one woman with ADHD and comorbidities in Chicago. “Because the gym is closed, I have had to develop a different habit around that. Anxiety makes it hard for me to get out the door to take a walk/jog but my partner takes one or two walks every single day so that makes it easier for me. We invested in some cheap technology so I can do exercise videos in front of the TV. The guided classes help me get motivated. My past work schedule actually made it easier for me to exercise at the gym and I really miss that.”
In some cases, parents are working hard to model healthy behavior for their children with ADHD, which prompts them to exercise more than they might have in the days of carpooling and lacrosse sidelines. “Walking, riding bikes, scooters, trampolines, and hula hooping are our choices for the day. Exercise is a must for our daily routine,” wrote one mother of a 10 and 13 year old. “I don’t know that I ever made exercise a priority before COVID-19.”
As with many healthy habits, getting started is often the hardest part. Once the habit begins to form, it not only sticks but also begins to grow. “I started a 100 Days of Yoga challenge about a month ago and now do yoga almost daily. This has led to more walks and desire to do other exercises as well,” wrote one young woman with ADHD and eating disorders.
ADHD Sleep Problems in the Pandemic
It’s well established that ADHD brains struggle with sleep. Sometimes this has to do with poor time management — staying up too late and paying the price when the alarm blares in the morning. ADHD brains also have a tendency to buzz with ideas, thoughts, and ruminations well past bedtime, keeping us awake and overwhelmed. Today, pandemic anxiety is also part of the equation.
Anxiety related to COVID-19 is causing disrupted sleep, and it’s also causing people to feel exhausted, ‘freeze,’ and take more mid-day naps than ever before in their lives.
“I am sleeping more because it is a coping strategy when I am overwhelmed, but I do not feel as rested,” wrote one parent.
“My sleep patterns have been disrupted because anxiety about loved ones has added to stress levels fueling depression,” wrote one adult with ADHD, depression, and PTSD. “I find myself losing time and my adult daughter has reported similar. She finds herself staring at the ceiling.”
The burden is even greater for essential employees who continue to report to work during the pandemic. On top of anxiety and worry (which may be exacerbated by leaving the house frequently), they are waking up to early alarm clocks while it seems the rest of the world is sleeping in.
“Anxiety induced insomnia and panic attacks are leading to disrupted sleep,” wrote one survey respondent. “But I’m working full-time so there is no time for naps during the day. I’m working exhausted, making mistakes, and falling behind.”
Adults with ADHD who are working from home and children learning from home are generally getting more sleep. Some even say that eradicating their commute has opened up time for sleep and exercise that they’ve never had before.
“The alarm clock goes off 1.5 hours later each weekday,” wrote one parent of two teenagers with ADHD. “Not only is there no commute, but we don’t even need to shower and get dressed. My teen wakes up 2 hours later on weekdays. He starts his school day later, and he showers and gets dressed at night.”
For others, the benefits of extra sleep can’t compensate for the larger life disruptions and anxieties associated with this pandemic.
“I’m sleeping in longer and it’s taking me even longer to get my day started,” wrote one parent with ADHD raising a teenager with anxiety. “I feel as if I’ve become to leisurely and lackadaisical. Losing my job, trying for weeks to get through to file for unemployment, and no in-person school for my 13 year old has continued to turn my once-structured life upside down. I feel like I no longer have a purpose.”
The Impact of Treatment on ADHD Symptoms in a Pandemic
As reflected in past surveys, most ADDitude readers (61%) are not making ADHD treatment changes right now. Just 16% of survey respondents said their treatment has become more consistent in quarantine; the remaining readers said they are skipping dosages, missing appointments, and generally not maintaining consistency of treatment during the pandemic.
The reasons for this inconsistency are varied. Some are worried about finances, so they have cut ADHD medication in order to save money. Others are staying away from doctors’ offices and pharmacies to safeguard themselves and their families against infection. Others are finding that, without the pressures of in-person school, their children don’t need medication for symptom control in the same way.
“We noticed that she was able to function without the meds and, upon consultation with her pediatrician, we stopped for the whole time she will be at home,”wrote one mother of 14-year-old twins. “Now we a happy child who is back doing creative things and playing her piano again! She is not a moody, grumpy, emotional roller coaster!”
Still others find that routine and schedule disruptions have thrown their treatment plans into disarray.
“Because of the lack of routine, my med regime has become quite scattered,” wrote one parent of two children with ADHD. “I forget to take my meds almost half of the time. I have managed to make sure my son gets his, though. Another example of how I am able to prioritize others, but not look after myself.”
Among those who reported less consistent treatment, nearly 58% said they are exercising less, 36% said they are sleeping less, and 35% said they are eating less healthy than before the pandemic. In all cases, this is about 10 points higher than the average, suggesting that a stable treatment routine helps to keep the rest of the tower from crashing to the ground.
“I understand more clearly how profoundly helpful it is to have habits and routines,” wrote one ADDitude reader. “The slow process of rebuilding my daily habits and routines (alone, with less external accountability) has made this time feel more like self-care, instead of feeling restrictive.”
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Updated on June 17, 2020