If RSD has thwarted your networking and job-seeking efforts, take these steps to manage discomfort and reframe your thoughts.

Think Differently About Networking

Sure, networking can feel awkward and embarrassing, especially if you struggle with low self-esteem. Remember that networking is about making connections and providing mutual help, no matter the career stage.

[Free Download: 8 Dream Jobs For Adults with ADHD]

If networking seems daunting, try setting up informational interviews. These one-on-one meetings emphasize learning, not landing a job, and are a casual, low-pressure way to pick someone’s brain, demystify job titles, and practice people skills. (Many professionals are happy to share their expertise.)

Reach out to professionals on LinkedIn or within your circle whose career trajectories interest you. Your college career center can connect you with alumni who will talk with you.

Don’t Take It Personally

If you haven’t landed a job, it’s not because you’re flawed. Perhaps you were up against strong applicants, or maybe your resume or cover letter needs work. Each of these factors can be addressed. Enroll in skill-building courses, carefully review feedback from hiring managers, and enlist help from friends, family, professionals, or your college career center.

Realize that the hiring decision often comes down to fit and not a judgment of your skills, worth, or potential. As you job search, try not to interpret rejection as a personal attack.

[Self-Test: Could You Have Rejection Sensitive Dysphoria?]

Make a Plan

Applying for jobs is time- and effort-intensive. Creating structure will ease overwhelm and fuel persistence.

• Keep a schedule for writing cover letters, updating your resume, searching job boards, building skills, and so on.
• Schedule breaks, exercise, meals, and other activities that keep you regulated — including time off social media, which can trigger unhelpful comparisons.
• Start and end your day with affirmations that reduce RSD.
  • A ‘no’ to my application is not a ‘no’ to my worth.
  • Every step I take builds resilience, no matter the outcome.
  • Not everyone will respond to my informational interview request, and that’s okay. At least I tried.
  • I’m focusing on what’s within my control.
• Try a change of scenery. Take your laptop to a coffee shop.
• Consider body doubling, which may boost accountability.
• Join online communities of fellow neurodivergent job seekers for insights and support.

Always remember that you are more than any job title.

Fear of Rejection in Job Searches: Next Steps from ADDitude

• Free Download: Understanding Rejection Sensitive Dysphoria
• Read: 7 Self-Defeating Behaviors That Aggravate ADHD – and How to Fix Them
• Read: 4 Steps to Claiming the Career You Deserve

Sharon Saline, Psy.D., is a clinical psychologist and the author of several books.

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Living with a compulsive need to please others and avoid conflict can be emotionally exhausting. With ADHD in the mix, self-esteem and communication skills can also suffer.

To achieve a healthier balance in your relationships, follow these seven steps.

1. Identify Root Causes

People-pleasing behaviors often stem from fear of rejection, low self-esteem, or past experiences in which you felt emotional safety hinged on accommodating others.

Perhaps you felt you had to fulfill your parents’ demands, no matter how unhealthy, or risk harsh punishment and emotional upheaval. Maybe you experienced rejection from your parents, peers, and other adults whose standards felt impossible to reach. A therapist can help you explore and understand the root causes of your people-pleasing behaviors and develop solutions for overcoming them.

[Read: How ADHD Impacts Sex and Marriage]

2. Set Boundaries

Self-respect grows from setting healthy boundaries and prioritizing self-care. This doesn’t mean you care less about your family; it means you care enough about yourself to make sure your needs are being met. Start with minor requests, learn to say no, and express your desires.

3. Speak Up

Have an honest conversation with your husband and family. Express your desire to change, A supportive partner will understand and help you with this transition. Effective communication can also prevent misunderstandings.

4. Reframe Thoughts

Many compulsive people-pleasers harbor negative thoughts and self-criticism. Are your fears based on proven facts or speculation? Cognitive behavioral techniques can be particularly helpful in reframing negative thinking patterns.

[Webinar Replay: Stop People Pleasing! Halting the Cycle of ADHD Self-Doubt, Perfectionism and Procrastination]

5. Practice Assertiveness

Being assertive means expressing your thoughts, feelings, and needs directly and respectfully. This can be challenging if you’re used to avoiding conflict, but there are many books, workshops, and therapies to help you build these skills. Participating in role-playing scenarios with a therapist or trusted friend can also help.

6. Embrace Self-Compassion

Be kind to yourself as you work through these changes. It’s normal to make mistakes and revert to old patterns occasionally. Instead of beating yourself up, acknowledge your progress and remind yourself that change take time.

7. Prioritize Mutual Respect

Healthy relationships are built on mutual respect and understanding. When you and your husband contribute equally to the relationship, it creates a more satisfying partnership and reduces the pressure to constantly please.

Breaking free from the cycle of pleasing people and avoiding conflict is not easy, but with patience, self-awareness, and support, it’s possible.

Stephanie Sarkis, PhD., is the author of Healing from Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse.

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The sensitive ADHD brain is wired to overreact. Big feelings flood your brain and fill it to capacity, blunting your ability to cope. Co-occurring conditions, like anxiety and mood disorders, may also intensify RSD and further degrade your coping abilities.

Use the following strategies to control your emotions, including RSD, in real time. Remember that key to better regulation is to practice coping skills even in times of calm.

⚡ Free Download! Scripts to Use When Emotionally Dysregulated

1. Turn Down the Volume

When RSD is coming at you fast, slow down those intense emotions — and allow the rational part of your brain to recover — with the following strategies:

• Acknowledge that you’re activated, then look for a healthy distraction; if you’re in a social setting, find a friend who can take your focus off your internal noise.
• If you’re caught off guard, buy yourself time to respond to an offhand remark or question with a canned response like, “That’s interesting. Let me think about it and get back to you.”
• Try a few rounds of triangle breathing; breathe in for four counts, hold it for four counts, exhale for six.
• Think QTIP (“quit taking it personally”). Consider the source — sometimes, a comment is simply a thoughtless one.
• Close your eyes and think of somebody who cares about you. What would they say to you in this moment?

2. Change Your Relationship to Worry

• Adopt a nickname for your worry. Always remember that you are not your worry; you are simply experiencing it. To help you disentangle from worry, treat it like a visitor.
• Talk to the feeling.  Say, “Worry, I understand that you feel like I can’t handle this, but I’ve got it. You can quiet down now.”
• Rejection may be the price of entry. In the interest of self-preservation, RSD might drive you to avoid situations where rejection and criticism are expected, as in the case of learning a new skill or standing up to lead a group. Do your best to look at your “why” when facing these situations. Think, “I’m willing to take a risk and see what happens.”
• You’ve survived it all. You’ve demonstrated resilience every time you survived and succeeded in the face of discomfort, rejection, and failure. Dig through your memory bank for those moments and think of the steps you took then to cope and overcome.

❗ Essential Read: How to Stop Catastrophizing

3. Prioritize Self-Care and Wellbeing

Continue to build your foundational toolkit. Your RSD strategies will work best when your mental health is being treated. Take your prescribed ADHD medication (and meds for other conditions), practice mindfulness, reduce stress, and do more of what you love.

Build satisfying social connections. The loving presence of caring and supportive friends and family is kryptonite to RSD. Surround yourself with like-minded people who accept you unconditionally. When meeting new people, take the pressure off by enjoying connection for connection’s sake. Show genuine curiosity and know that everyone has insecurities.

Redirect your attention to all things good. RSD warps perceptions and can make you feel like there is something fundamentally wrong about you. Tip the scales by noticing positives in yourself and around your life — an exercise both in mindfulness and resilience. Make it a daily habit to think of three good things that happened to you. And instead of catastrophizing, think, “What could go right?”

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “RSD Toolkit: Strategies for Managing Your Sensitivities in Real Time” [Video Replay & Podcast #476] with Sharon Saline, Psy.D. which was broadcast on October 19, 2023.

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RSD wouldn’t be RSD if it didn’t alter people’s perceptions. This is precisely how it functions and multiplies. A sideways glance or a mumbled response can trigger a misinterpretation that leads to an exaggerated response. Either way, with RSD, real or perceived rejection and disapproval cause extreme emotional pain.

When somebody fears rejection, they scan for signs of it everywhere. They misinterpret social cues, and then try to protect themselves by avoiding provocative situations. Curiously, they may even act in ways that increase the likelihood of rejection, assuming it’s inevitable.

If you are anticipating emotional upheaval at all times, your perception is bound to become distorted. Teens with ADHD are especially likely to misperceive situations and react strongly to events that may not truly warrant a response.

Follow these steps to help your teen understand and manage RSD.

Broaden the Scope

Approach your teen about RSD when she’s calm. Say, “I heard a talk about this thing that might be related to our family.” (If one family member has ADHD, chances are that others in your immediate family also have ADHD and could benefit from this information.)

Then explain that there is nothing wrong with feeling things deeply. When she feels pained by a situation, validate her feelings and ask questions. This will help her think critically about what happened and, perhaps, re-evaluate her sense of the situation.

Encourage her to discuss her thoughts with someone outside the situation who can offer a more neutral perspective.

Understand Triggers

To improve your teen’s ability to handle RSD, help her plan ahead:

• What situations trigger her, and how does she know she’s becoming upset?
• What are the signs of discomfort?
• What can she do to create distance and slow down when she feels upset? Perhaps go for a walk, take some deep breaths, or say a few calming phrases?

Support Working Memory

Individuals with strong working memory are less reactive to events and more capable of accurately assessing emotional situations than those with relatively weak working memory. Help your teen learn to externalize information, avoid multitasking, and repeat instructions back to you to build this skill. Work with her to recall successful responses to distressing situations from the past and brainstorm how to apply these in the present or the future.

This article was derived from the ADDitude ADHD Experts webinar, “Big Kids, Big Emotions: Helping Teens with ADHD and Rejection Sensitivity Improve Emotional Regulation [Video Replay & Podcast #563] with Sharon Saline, Psy.D., which was broadcast on June 11, 2025.

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The more I’ve reflected, the more I’ve come to understand that RSD — with its all-consuming episodes accompanied by shame and a desire to withdraw or spiral — is about far more than rejection or emotional sensitivity.

RSD gets to our deep-seated fears about letting the world see the real us. RSD is really about the panic of being unmasked. I see this as “unmasking dysphoria,” a trauma-linked reaction to being exposed in ways that feel unsafe.

The Cost of Masking

Neurodivergent people learn to mask, or hide the traits that make them different, to navigate environments not built for their brains. It’s not a choice but a survival strategy to avoid punishment, misunderstanding, or exclusion.

Masking takes on many forms. It can look like overcommitting (to ward off suspicions of incompetence), manufacturing urgency (because external pressure is needed to finish tasks), scripting and rehearsing conversations, and obsessively rereading messages. It can look like keeping a low profile to avoid saying something impulsive or “stupid” and being exposed.

[Read: 7 Masks We Use to Hide Our Faults]

Masking requires constant self-monitoring and adjusting, leading many people to feel on edge all the time. Some of my clients describe it as a low-level fear of getting in trouble for doing something wrong, a feeling enforced by past instances of being reprimanded for their symptoms.

Masking, especially in the long-term, harms mental health. It forces people to internalize that their natural way of being is wrong and unacceptable. This chronic invalidation and exclusion of the self is a form of trauma that rewires the nervous system. Even if it doesn’t meet the traditional definition of trauma, it changes how we emotionally respond to the world. It’s why moments when the mask slips feel not just uncomfortable, but unsafe.

This Isn’t Just Sensitivity

Many people, with or without ADHD, are sensitive to criticism. But RSD runs deeper. It’s about fear of exposure.

The people who experience RSD most intensely are those who have mastered masking. They have gone to great lengths to hide their neurodivergence, allowing the world only to see (a version of) competence, not the immense mental load beneath.

[Read: I Can’t Handle Rejection. Will I Ever Change?]

But when traits they’ve worked so hard to suppress suddenly show, things collapse. The world has caught a glimpse of their true, flawed self. They spiral, withdraw, and melt down, not because anyone rejected them, but because they no longer feel safely hidden.

This is how I felt when I froze during a mock interview recently, despite prepping for days. I felt ashamed beyond embarrassment.

My brother said, “This is just an RSD episode — you’re not thinking clearly. It’s going to pass.” He was right. But the shame wasn’t about the interview. It was about the mask slipping and a part of me being exposed that I’ve spent my life trying to manage or hide.

It’s not always about fear of public exposure. A client lost his passport, canceling a vacation no one else knew about. There was no rejection involved. But he still spiraled into shame because his hidden disorganization surfaced. It was the loss of his mask, even to himself, that hurt.

A Different Framing: Unmasking Dysphoria

RSD is a trauma-related response to involuntary unmasking. What appears as emotional overreaction often reflects the nervous system’s response to unmasking and thus perceived exposure, regardless of whether the person consciously recognizes it.

Not all triggers link directly to ADHD traits or obvious masking. Triggers can be breakups, delayed texts, or vague feedback. The core fear remains: being too much, too difficult, or defective. Many with ADHD carry these narratives after adapting to unwelcoming environments. In those moments, what surfaces isn’t just fear. It’s unmasking dysphoria.

This view aligns with principles of trauma-informed care, which recognize how feeling safe, having a sense of control over one’s life, and understanding past experiences shape emotional responses.

Key points:

• The real trigger is the perception of being unmasked.
• The emotional intensity isn’t fragility but collapse after years of effortful self-monitoring.
• These feelings tie back to identity, shame, and safety.

Why the Reframe Matters

As a trauma-informed clinician and a person with lived experience, I believe this framing deserves deeper research, especially for those with ADHD who carry emotional wounds from chronic invalidation. Better understanding the why behind RSD can guide interventions beyond surface emotion regulation toward reducing shame and increasing self-acceptance and healing.

This understanding also helps validate the exhaustion caused by masking and honors its protective role. It encourages separating performance from worth and treating the emotional collapse as a predictable, reasonable trauma-related response.

Ultimately, this shift moves the focus from sensitivity to survival and pathology to context —allowing people to receive deeper support, develop self-understanding, and show up fully and unapologetically.

Rejection Sensitivity, Masking, and ADHD: Next Steps

• Read: “Masking with ADHD Is the Ultimate Energy Drain”
• Read: “We Are Who We Are. There’s No Shame in That.”
• Read: You Are Enough — How to Counteract ADHD Imposter Syndrome

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Children with ADHD endure frequent criticism or negative feedback from parents, teachers, other adults, and peers, and this steady stream of judgment often degrades their self-esteem. When emotional outbursts, poor social skills, and disorganization are misunderstood in school and at home, that may lead kids to internalize negative beliefs about themselves.

This webinar will offer age-appropriate practical tools to help adults build resilience and self-confidence in children with ADHD, from elementary school through high school. Participants will learn how to use supportive language, foster self-advocacy in their children, and apply strategies that make a lasting impact.

In this webinar, you will learn:

• • Why children with ADHD are prone to low self-esteem and how negative thinking patterns impact kids all the way through adulthood
  • About successful parenting strategies to build self-confidence across different age groups, including what to say and what is well-meaning but should be avoided
  • Practical scripts to teach kids how to advocate for themselves, manage criticism, and push back against stigma
  • Effective ways for parents to collaborate with schools and other professionals in supporting your child’s resilience and self-esteem
  • Subtle approaches to communicate with and educate others (e.g., coaches, other caregivers, extended family members) to incorporate more inclusive and compassionate language

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

Webinar Sponsor

Play Attention is more than a tool – it’s a confidence-building program for children with ADHD. Shaped by over 3 decades of practice, proven outcomes, and research by Tufts University School of Medicine, Play Attention uses NASA-inspired neurotechnology to strengthen executive function. Your child can build self-control, improve focus, and develop the resilience to grow with confidence.

Take our online ADHD assessment or schedule a consultation to see how Play Attention can support lasting self-esteem and success. Home and professional programs available. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Self-confidence and Resilience with ADHD: Resources

• • • Free Download: Evaluate Your Teen’s Emotional Control
    • Read: How to Invest In Your Child’s “Emotional Bank Account”
    • Read: Why We Feel So Much — and Ways to Overcome It
    • Read: 6 Behavioral Parent Training Programs for ADHD Families

Obtain a Certificate of Attendance

If you attended the live webinar on July 10, 2025 watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Larisa Litvinov, Ph.D., is a senior psychologist in the ADHD and Behavior Disorders Center at the Child Mind Institute. Dr. Litvinov has more than 20 years of experience in the evaluation and treatment of behavioral, anxiety, and mood disorders in children, adolescents, and adults.

Dr. Litvinov has worked extensively with children who’ve been diagnosed with PTSD, depression, anxiety, and ADHD. She has expertise in dialectical behavior therapy (DBT), parent-child interaction therapy (PCIT), trauma-focused cognitive behavioral therapy (TF-CBT) and child-parent psychotherapy (CPP).

Dr. Litvinov has certifications in the Reflective Parenting Program and Adoption Specific Therapy (ADAPT), as well as PCIT. She also specializes in early childhood mental health and adoption-specific treatment. She has found that working with children who has experienced chronic trauma requires looking beyond the diagnoses and using the adoption, trauma, biological, and developmental lenses to understand and help children and their families.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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A: People with rejection sensitive dysphoria (RSD) experience extreme emotional pain related to real or imagined rejection, and they often respond intensely to any perceived injury or threat. In relationships marked by RSD, it’s difficult for one partner to separate amid distress.

Follow these four strategies to reduce conflict and halt toxic patterns.

#1. QTIP (Quit Taking It Personally)

Listen to your gut. If your partner’s bad mood really about you? If you’re lecturing, yelling, or interrupting instead of listening to your partner, ask yourself, “Why am I talking?”

#2. Use a ‘Takeback of the Day’

Here’s how this forgiveness freebie works: Each day, you or your partner can say, “I said something I regret. I’d like it to be my takeback.” Then the receiver agrees to take a breath and figure out how to forgive the partner without resentment.

[Read: How ADHD Impacts Sex and Marriage]

#3. Extend the Benefit of the Doubt

Don’t assume your partner has done something purposely harmful, painful, inappropriate, or irresponsible. Get some clarity by using “I” statements such as “I’m curious about,” “I wonder,” “It’s confusing to me,” “I was surprised,” or “It hurt me when…”

#4. Follow These STEPS

This five-step plan can help dysregulated couples reverse course, cool down, and move forward.

• Self-control. During intense conversations, focus on the physical signals that suggest you’re becoming activated. Is your heart beating faster? Are you perspiring or speaking louder? You can avoid a massive eruption if you catch your dysregulation early.
• Time apart. Establish a plan for signaling when you need a break during a conflict (one of my clients says, “giraffe”) and for taking time apart to cool down and stabilize. Agree on what works for both of you.
• Evenness. Being accountable for your actions returns relationships to baseline. Consider why you are upset and what you could have done or said differently. How can you express your thoughts or desires more effectively and empathically next time?
• Practice reflective listening. When intense feelings escalate, designate one person as the talker and the other as the listener. The talker says what’s on their mind, uninterrupted, for a set time. Then, the listener reflects and repeats what they heard – “What I heard you say is X. Did I get that right? Is there anything else?” Reset the timer and switch roles so each person is heard.
• Strategize. Set small goals that nurture positive connections. Schedule monthly date nights, or make it a daily goal to recognize something your partner did for which you’re thankful or grateful (e.g., “Thanks for cooking dinner.” “I really liked how you folded my clothes.”).

[Read: How ADHD Ignites RSD]

Q: As the non-ADHD partner, my concerns rarely get addressed. Everything I bring up is taken as a criticism or an attack that elicits strong reactions from my partner. I feel stuck and unheard, always walking on eggshells. What can I do?

A: Your question signals that you and your partner are not connecting as equals. I recommend discussing how to comfortably ask for help using questions based on curiosity, not blame.

• “How do we want to ask each other for help and support? The way we’re doing it isn’t working.”
• “When I tell you something, it seems that your reaction is anger and defensiveness. How should I say things in a way that would be easier for you to hear?”
• “How can I help you slow down and manage your feelings?”
• “I noticed that you looked at me. Was there anything behind that look? I’m prone to interpreting that look as a criticism, and I’m wondering what the thinking was behind it.”

If you are uncomfortable having this conversation, I strongly encourage you to find a couples therapist.

Hurt Feelings & Shame Spirals: Next Steps

• Read: 11 Rules for Fighting Right and Forgiving Faster
• Free Download: Manage ADHD’s Impact on Your Relationship
• Read: When You’re So Sensitive It Hurts
• Read: The One Ground Rule for Fighting Fair in an ADHD Marriage

Sharon Saline, Psy.D., is a clinical psychologist and the author of The ADHD Solution Deck.

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Does your teen with ADHD overreact to small comments, withdraw suddenly, or seem constantly on edge? They may experience rejection sensitive dysphoria (RSD), a phenomenon common with ADHD. Not a formal diagnosis, RSD refers to intense feelings of pain following an actual or perceived rejection; a person with RSD may anticipate someone pulling back friendship, love, or support over a gesture, a misunderstanding, or a small disagreement.

Parenting teens with ADHD typically means navigating intense emotional storms, executive functioning challenges, and unpredictable hormonal shifts. When you add RSD to the mix, this combination can feel overwhelming and exhausting for everyone.

This webinar is designed to increase your ability to understand what’s really going on beneath the surface and to offer support through the ups and downs of adolescent sensitivity with compassion and clarity. Award-winning author, international speaker, and consultant Dr. Sharon Saline will explain how to manage the heightened emotional sensitivity in teens that often accompanies ADHD. After discussing the science behind RSD and how it relates to social anxiety, she will explore how hormonal changes in adolescence amplify emotional intensity and increase dysregulation in teens. Dr. Saline will show you how to assist kids in identifying triggers, reducing negative self-talk, and lowering shame. You’ll learn practical, evidence-based strategies for helping your adolescents feel more in control of their emotions, more connected to you, and more confident in themselves.

Learning Objectives:

• Understand the connections between ADHD and RSD in teens
• Learn how hormonal changes during puberty impact brain development, mood swings, and emotional sensitivity
• Recognize common signs of Rejection Sensitive Dysphoria (RSD) in teens, including emotional shutdowns or outbursts
• Gain practical tools for de-escalating emotional outbursts and helping your teen name, manage, and recover from big emotions
• Explore communication strategies that foster trust, reduce shame, and build resilience

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

Webinar Sponsor

RSD is common in teens with ADHD—but it’s manageable. Play Attention uses NASA-inspired technology that lets users control cognitive exercises with attention alone, empowering your teen to build focus, emotional regulation, and resilience. Proven to improve executive function and backed by Tufts University research, our program blends AI-powered personalization with a dedicated focus coach—for that human touch. Start with our ADHD test or schedule a consultation. Home and professional programs available. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

RSD in ADHD Teens: Resources

• Free Download: Evaluate Your Teen’s Emotional Control
• Read: How ADHD Ignites RSD: Meaning & Medication Solutions
• Read: Have a Teen with ADHD? Encourage Communication & Avoid the Drama
• Read: The Key to ADHD Emotional Regulation? Cultivating Gratitude, Pride & Compassion
• eBook: The Parents’ Guide to Raising a Teen with ADHD, Part One

Obtain a Certificate of Attendance

If you attended the live webinar on June 11, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Sharon Saline, Psy.D., is a clinical psychologist and author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life and The ADHD Solution Deck (#CommissionsEarned) specializes in working with children, teens, emerging adults and families living with ADHD, anxiety, learning disabilities, autism, twice exceptionality and mental health issues. Her unique perspective, as a sibling in an ADHD home, combined with decades of experience as a clinical psychologist and educator/clinician consultant, assists her in guiding families and adults toward effective communication and closer connections. She lectures and facilitates workshops internationally on topics such as understanding ADHD, executive functioning, anxiety, motivation, different kinds of learners, and the teen brain. Dr. Saline is a regular contributor to ADDitude and Psychology Today, a featured expert on MASS Appeal on WWLP-TV, and a part-time lecturer at the Smith School for Social Work. Her writing has been featured in numerous online and print publications including MSN, The Psychotherapy Networker, Smith College Studies in Social Work, Attention Magazine, ADDitude Magazine, Psych Central, and Inquirer.com. Learn more at www.drsharonsaline.com.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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Strong self-advocacy skills — i.e., the ability to ask for and secure support when it matters — is a strong indicator of success for people with ADHD. Everything from executive dysfunction to the emotional impact of ADHD and its comorbidities are made more manageable with the right kind of help. But the same ADHD characteristics that make assistance so important also make asking for it really tough.

So we asked ADDitude readers to share their experiences with self-advocacy and offer any tips, hacks, or hints that have helped them get helpful help. Here’s what they told us:

Why We Ask for Help

“I see requests for help as opportunities to build relationships and connections.” —Catherine, Washington

“When I ask for help, it makes me feel like a failure. But I remind myself that I need to set an example for my kids, so I will ask my husband for help by explaining that I need to prioritize something else so can he please cook dinner?” —Kate, Australia

[Read: The Fear of Failure Is Real — and Profound]

“I’m midlife and the gig of doing it all by myself is up: I have crashed and have to ask for help now. The trick is choosing relationships in every area of life with people who have high standards of relations, reciprocity, and compassion. I choose now, rather than hoping others will get me. It changes everything!” —An ADDitude Reader

“I think having a background in addiction recovery is an asset to ADHD coping. I am already aware that in some areas, I need support outside of myself. Therefore, I am already practiced in asking for support. I know that if I try to cope on my own, it may lead to unhealthy behaviors.” —Krysta, Canada

“I have a 15-minute rule. If I am stuck for more than 15 minutes, I ask for help. I instill this in my employees as well. Asking for help tells me that they are comfortable with communication, and humble.” —John, Florida

“If I notice my RSD is preventing me from asking for support, that often indicates that I’m not getting what I need from that relationship to feel safe.” —AJ, Utah

[Read: How ADHD Ignites RSD – Meaning & Medication Solutions]

How We Ask for Help

“I prefer typing out a text or email rather than orally asking for help, but if text/email is not an option, writing a script can help me prepare for a face-to-face request.” —Chandler, Pennsylvania

“Ask for something super tiny to get practice at asking for help.” —Katrina, Australia

“I have set up keywords with my husband, so when I say those words he knows I am feeling lonely and I need help.” —April, Oklahoma

“My ADHD can make me quite impatient, so I need to give people time to process my request, or take the action I’ve asked for. It helps to remember this isn’t rejection, and they don’t have to drop everything then and there in order to be willing to help.” —Trish

“To address loneliness, I have learned to say ‘I need a hug.’ Often it opens the door for me to share more about what is going on.” —Claire, Pennsylvania

“I identify a person with complementary skills, and I spontaneously contribute to our shared objective by doing the tasks they find laborious. The reciprocal task division follows naturally. Nobody has to ask, no gift debt is engendered. We are actively helping each other.” —Dettie

“I imagine that I’m giving someone good news when I’m about to ask for something I feel nervous about.” —Kelsie, Mississippi

“I have to just accept that asking feels awkward, and it probably always will.” —Sarah, Georgia

“I always express gratitude to any person who is willing to body double with me and I describe how it was helpful. For example, ‘You read your book while I was doing bills and I got sooo much more done. Thank you. Let me know when you are reading your next book.’” —An ADDitude Reader

“I offer help, often. That makes me feel better about asking for help. In my mind, I’ve kind of already paid for the help that I need by helping others, and now I’m cashing out.” —Helen, Maryland

“I practice a lot of ‘I statements,’ like, ‘I feel so overwhelmed by the number of tasks I have to do and I need extra hands.’ It’s not easy, but if you start with positive ‘I need’ statements, and practice, it’ll start feeling like second nature.” —Vanessa, Texas

“I try to set up check-ins with team members at work so it’s easier to ask for help while working on a specific project.” —Christina, Louisiana

“Give yourself 10 seconds of bravery. Start counting backwards from 10 and, before you hit one, say what you need to say to the person.” —Charlie, Australia

“Before asking for help at work, I always make sure to have a list made up of things I need help with. It shows my boss and team members that I have come prepared, with a plan.” —Melissa, Minnesota

“I have realized that I need to be very concise and direct when asking for help, instead of talking about how much I need help and giving reasons.” —An ADDitude Reader

“I use an app such as Goblin Tools to break down tasks, then I ask for specific help. I find that if I say I need help in a non-specific way, people are less ready to help, but if I say, ‘Can you declutter this one drawer please?’ then I’ll get help. The act of breaking the task down helps reduce my overwhelm, too.” —Laura, New Zealand

“One thing that helps is to talk to friends about what is going on, just to gauge what their capacity is for listening or coming up with solutions I am blind to. More eyes and brains on a problem are a good thing.” —Sarah, Germany

“With my teenager, it is mostly a choice-based, task-related ask: ‘Would you be willing to help me with Option A or Option B and at what time?’” —Kristen, Michigan

“At work, I have a personal checklist of resources to exhaust. If I can’t find the answers after doing due diligence, I reach out to an appropriate team member. Having researched on my end allows me to reach out with a more informed and confident ask for help.” —Sharon, Ohio

ADHD Self Advocacy: Next Steps

• Quiz: Rejection Sensitive Dysphoria Symptom Test
• Quiz: How Severe Is Your Loneliness?
• Download: The Emotions of ADHD

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Without fail, all of my female clients reply, “They are laughing at me.”

This painful thinking pattern – sensitivity to rejection – is etched into our brains, a pattern that arguably developed for an evolutionarily adaptive purpose. It’s also a pattern that appears to be much more amplified in the female ADHD brain.

Rejection Is an Existential Threat

According to neuropsychiatrist Louann Brizendine, M.D., author of The Female Brain (#CommissionsEarned), girls’ brains are “machines” that are “built for connection.” From infancy, girls respond more to the cries of other babies and gaze longer at faces compared to boys.

Unlike men, who are physically larger and stronger, women have historically needed other people and social connections to ensure their own safety and that of their offspring. The female brain, Brizendine posits, likely tuned into the potential for social rejection as an evolutionarily protective function.

So great is the fear of exclusion among women that it informs bullying behaviors. Peer relationship research shows us that, unlike males, who engage in more physical forms of bullying, females generally rely on more relational or reputational methods, such as excluding another girl from their social group, spreading rumors, or saying something mean directly to the victim’s face. In other words, we toy with other females’ emotions by threatening exclusion from an early age because that is really what we fear the most — being rejected and alone.

[Take the RSD Self-Test: Rejection Sensitive Dysphoria Symptoms]

The ADHD Brain and Emotional Reactivity

The amygdala, which Brizendine describes as the brain’s “emotional gatekeeper,” is where fear and anger are initially processed. Once the amygdala detects a threat — real or perceived — that information is sent to the hypothalamus. The hypothalamus then heightens the uncomfortable fight-flight sensations (e.g., faster heartrate and breathing) we experience when we are anxious or angry. The amygdala also sounds the alarm to the prefrontal cortex (PFC), the executive functioning center of the brain, which then decides whether and how to react.

And here lies the pivotal point where the differences between girls with and without ADHD come to light. Our ADHD brains, prone to greater emotional flooding, crank up the volume on the aforementioned process. Our fear of exclusion is amplified. We interpret a situation as threatening when it likely isn’t.

Regardless, our brains get carried away with the threat. The alarm bells of “danger” ring, ring, and ring. We struggle to regulate, and, due to poor executive functioning, we struggle to respond effectively. There’s a reason psychiatrists Edward Hallowell, M.D., and John Ratey, M.D., describe the ADHD brain as a Ferrari equipped with bicycle brakes.

The way those of us with ADHD experience rejection is so unique that there’s a term for it: rejection sensitive dysphoria (RSD). Psychiatrist William Dodson, M.D., notes that some of his patients with RSD even describe feeling physical pain – as if they’ve been stabbed in the chest – as a response to rejection.

[Read: How Does RSD Really, Actually Feel?]

I can attest to this; after I got into an argument with someone very close to me, I sobbed in my husband’s arms and could only say, “It hurts.” Yes, I was hurting emotionally. But I was also in literal, physical pain. The female brain’s propensity to relay intense emotions into actual physical sensations is not lost on me. Feelings of emotional pain can register as physical pain responses for us, according to Brizendine.

As women, but especially as women with ADHD, our brains are wired to scan for rejection at every turn. Yes, this probable evolutionary adaptation – developed for protection – is turbocharged under ADHD. Yes, RSD and emotional reactivity are the excruciating result. But our sensitivity and ability to feel deeply, dare I say, has its advantages, too.

Fear of Rejection, RSD, and ADHD: Next Steps

• Free Download: Understanding Rejection Sensitive Dysphoria
• Read: Rejection Sensitivity Is Worse for Girls and Women with ADHD
• Read: “RSD Has Blessed Me with an Immense Capacity for Feeling — and I’m Grateful.”

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The lives of girls and women with ADHD are jeopardized by exponentially higher rates of self-harm, suicidality, and intimate partner violence, as compared with their neurotypical counterparts or with neurodivergent boys and men.

“ADHD in girls portends continuing problems through early adulthood that are of substantial magnitude across multiple domains of symptomatology and functional impairment,” write the authors of the Berkeley Girls ADHD Longitudinal Study (BGALS) follow-up study.¹ “The sheer range of negative outcomes is noteworthy; the most striking include the high occurrences of suicide attempts and self-injury in the ADHD sample, confined to the childhood-diagnosed combined type.”

What We Know About Self-Harm

“Girls with combined-type ADHD are 2.5 times more likely to engage in non-suicidal self-injuring behavior than are their neurotypical peers, and 3 to 4 times more likely to attempt suicide,” said Stephen Hinshaw, Ph.D., lead author of the BGALS study, in an ADDitude webinar titled, “Girls and Women with ADHD.” It’s important to note, Hinshaw says, that self-harm is a “potent indicator” of future suicide attempts.

This is an arresting statistic, particularly considering how self-harm and suicidality have spiked in adolescent girls in general. The most recent CDC Youth Risk Behavior Survey (YRBS) report found that 1 in 10 girls has attempted suicide, and 1 in 3 of girls seriously considered suicide during the past year, which is an increase of nearly 60% from a decade ago.

Research suggests that neurodivergent girls face a significantly higher risk for self-harm than do neurodivergent boys, or neurotypical people of any gender. A 2020 study in European Child & Adolescent Psychiatry found that the rate of self-harm was four times greater in females than it was in males (8.7% vs 2.2%).²  A 2022 ADDitude survey found reports of self-harm among 18% of girls with ADHD versus 9% of boys with ADHD.

The correlation between teen girls with ADHD and self-harm is so strong that a 2021 study published in Child and Adolescent Mental Health proposed that all teen girls treated for self-harming behavior should be screened for ADHD:³ A full 83% of teen patients admitted to the hospital for self-harm were girls, the study found.

Indeed, early diagnosis and treatment of ADHD is critical to mitigating the risk of self-harm. “Girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide,” says Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.

What We Know About Intimate Partner Violence

Low self-esteem, high rejection sensitive dysphoria (RSD), and social skill deficits put women and girls with ADHD at heightened risk for intimate partner violence (IPV). A study published in the Journal of Abnormal Child Psychology found that: ⁴

• Girls with ADHD were five times more likely to be victims of physical intimate partner violence than non-ADHD girls (30% vs. 6%)
• Greater ADHD symptom severity in childhood was associated with increased risk for physical victimization

“Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships,” write the authors of the study. “Given the devastating impact of intimate partner violence, additional research on how to empower females with ADHD in their social and romantic relationships is greatly needed.”

What We Know About Substance Use

The connection between SUD and ADHD has been well-established through research. We know that:

• People with ADHD are three times more likely to develop an SUD then those without⁵
• 25% of adults with SUD have ADHD⁶ 
• SUD is often more severe in individuals with ADHD⁷

Among the general population, we know that teen girls are more likely to use substances than are teen boys. According to the CDC’s YRBS:

• Alcohol: 27% of teen girls reported drinking in the last month vs 19% of boys
• Vaping: 21% of girls reported vaping in the last month vs 15% of boys
• Illicit drugs: 15% of girls reported ever using illicit drugs vs 12% of boys
• Misuse of prescription opioids: 15% of girls reported ever misusing opioids vs 10% of boys

That said, studies on the prevalence of SUD among girls and women with ADHD have resulted in mixed findings. An elevated risk of substance use was found in a large-scale study led by Joseph Biederman, M.D.,⁸  however no such association was found in the BGALS follow-up.

Most recently, researched at the University of Minnesota conducted a study investigating how ADHD symptoms may influence substance use in women and men, and it found a stronger association between alcohol use and ADHD for young adult women than for young adult men.⁹

“The current study confirms that ADHD-associated risk for adult substance problems is consistently greater in magnitude for women,” the authors of the study write. “The presence of adult ADHD increases risk for substance problems in women more than men.”

What We Don’t Know

No research exists on the relative efficacy of interventions that may reduce the risks for self-harm, suicidality, intimate partner violence, and substance use among girls and women with ADHD. Without fully understanding where these threats begin and how they escalate, we cannot devise and adjust solutions.

The BGALS follow-up study found elevated risks of self-harm and suicidality only among girls with combined-type ADHD, and not among those with inattentive symptoms alone, which leads researchers to speculate that impulsivity is associated with higher risk. Researchers also posit that psychosocial factors, such as the teen’s environment, contribute to the likelihood of self-harm. Longitudinal research is needed, however, to confirm this.

“What are the transition points — psychologically, family or school-related, community-wide — that predict impairment vs. resilience for girls with ADHD as they transition through adolescence to adulthood?” asks Hinshaw. “What are the strategies and supports that teen girls and women with ADHD find most helpful in self-advocacy and thriving?”

In the British Journal of Psychiatry,¹⁰ Hinshaw and doctoral student Sinclaire O’Grady call for longitudinal research on long-term correlated outcomes, such as the development of borderline personality disorder, as well as research into the intergenerational transmission of risk for negative outcomes in the children of women with ADHD.

Further research is needed to answer the following questions:

• What are the specific predictors and mediators of the high risk for self-harm in girls and women with ADHD?
• Does screening self-harming teens for ADHD reduce the occurrence of self-harm?
• What, exactly, makes early adulthood a time of heightened risk for substance use issues, specifically for women with ADHD?
• What are the impacts of ADHD treatment on intimate partner violence victimization?
• What psychosocial interventions, specific to girls and women with ADHD, may mitigate risk of intimate partner violence victimization?

Why It Matters

Researching suicidality, self-harm, intimate partner violence, and substance abuse among women with ADHD will, quite literally, save lives.

A study led by Russell Barkley, Ph.D., published in the Journal of Attention Disorders, found that life expectancy was 13 years lower for patients with combined-type ADHD diagnosed in childhood and with persistent symptoms, relative to control children.¹¹

However, because of the severely limited number of females in the study, the findings are largely not relevant. No major study has investigated the impact of ADHD on life expectancy specifically in women.

With dramatically higher rates of self-harm and suicidality, as well as intimate partner violence, this research is desperately needed to protect women from bodily harm, as well as devastating emotional consequences.

What ADDitude Readers Tell Us

Feelings of loneliness, RSD, emotional dysregulation, anxiety, and low self-worth exert a crushing emotional burden — and prompt some readers to harm themselves, to abuse substances, and to maintain toxic relationships.

“I made poor choices that led to abuse,” says Debs, an ADDitude reader in the United Kingdom. “I’ve taken substances to make the pain less, and I have self-harmed to try to take away the pain.”

“The inner turmoil just seems to get louder and louder and more difficult to turn down, which leads to unhealthy ways of coping like self-harm to help manage the stress,” shares Laura, an ADDitude reader in Texas.

“I abuse cannabis,” explains ADDitude reader Elizabeth, in the United Kingdom.

“Sometimes I feel worthless and want to self-harm because of RSD, assuming I’m not loved by my loved ones.”

“I get myself in relationships that aren’t good for me as I’m just happy that somebody finally loves me despite my flaws,” explains ADDitude reader Annika in Germany. “Self-harm comes into play when I feel like a failure because the relationship is rocky, and I get invalidated or criticized.”

“I constantly feel like I’m failing, which makes the thoughts about self-harm pop up often, although I haven’t given in to those for a while now,” says Lizzy in the Netherlands.

“I drink a lot right now,” says Nicole, an ADDitude reader in Washington. “I know it is unhealthy, but it is the only way for me to cope.”

“I have a history of self-harm, which was sometimes brought on my intense feelings of worthlessness and loneliness,” shares an anonymous ADDitude reader.

What ADHD Experts Say

The long-term ravages of underdiagnosed and undertreated ADHD in women are dire — a matter of life and death in some cases. To develop effective interventions, research is essential.

“There is a critical need for studies into how increasing degrees of isolation, shame, and despair lead to self-harm and earlier mortality, exploring the relationships to early chronic trauma, impulsivity, poor self-care,” says Ellen Littman, Ph.D. “Research must respond to outcomes signaling such a significant public health crisis.”

“Too little is known about later-adult outcomes of females with ADHD,” write Hinshaw and O’Grady. “Overall, we contend that the extraordinarily high risk for self-harm incurred by girls with ADHD as they mature requires a shift in clinical perspective.”

“Girls and women with untreated or undertreated ADHD — or those who have been misdiagnosed with other conditions — have been put at higher risk for an array of negative outcomes including higher rates of depression and anxiety, intimate partner victimization, and risky sexual behaviors resulting in teen and unplanned pregnancies,” says Schechter. “Research specifically devoted to girls and women with ADHD is not only an issue of equity but a life-or-death issue for some girls and women.”

Self Harm & Intimate Partner Violence: Related Resources

• Suicide &Crisis Lifeline: Call or Text 988
  988lifeline.org
• National Sexual Assault Helpline: 1-800-656-HOPE
• National Substance Abuse Helpline: 1-800-662-HELP
• Stop Bullying

Related Reading

• Teen Girls Are Not Alright. ADHD Magnifies the Crisis.
• ADHD in Women and Girls: Why Female Symptoms Slip Through Diagnostic Cracks
• Why Do Toxic Relationships Swallow People with ADHD?
• Girls and Women with ADHD: Unique Risks, Crippling Stigma
• Substance Use Disorders and ADHD: 5 Key Facts and Additional Resources
• “If the Story of My Unplanned Pregnancy Helps Just One Person, It Was Worth Sharing.”

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹ SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

² Ohlis, A., Bjureberg, J., Lichtenstein, P. et al. Comparison of suicide risk and other outcomes among boys and girls who self-harm. Eur Child Adolesc Psychiatry 29, 1741–1746 (2020). https://doi.org/10.1007/s00787-020-01490-y

³ Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

⁴ Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

⁵ Wilens T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. The Psychiatric clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8

⁶ Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 9–21. https://doi.org/10.1016/j.jaac.2010.09.019

⁷ Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956

⁸ Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Klein KL, Price JE, Faraone SV. Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biol Psychiatry. 2006 Nov 15;60(10):1098-105. doi: 10.1016/j.biopsych.2006.02.031. Epub 2006 May 19. PMID: 16712802.

⁹ Elkins IJ, Saunders GRB, Malone SM, Wilson S, McGue M, Iacono WG. Differential implications of persistent, remitted, and late-onset ADHD symptoms for substance abuse in women and men: A twin study from ages 11 to 24. Drug Alcohol Depend. 2020 Jul 1;212:107947. doi: 10.1016/j.drugalcdep.2020.107947. Epub 2020 Feb 27. PMID: 32444170; PMCID: PMC7293951.

¹⁰ O’Grady SM, Hinshaw SP. Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm. Br J Psychiatry. 2021 Jan;218(1):4-6. doi: 10.1192/bjp.2020.153. PMID: 33019955; PMCID: PMC7867565.

¹¹ Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders, 23(9), 907-923. https://doi.org/10.1177/1087054718816164