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Writer's pictureSara Tookey
Aug 1212 min read

The Hidden Struggle: When High-Functioning ADHD in Adulthood Leads to Burnout and Breakthrough

Updated: Oct 25

Written by Dr Sara Tookey


High-functioning ADHD as a Swan, appearing calm and graceful, yet padding frantically beneath - True North Psychology


Imagine a swan gliding gracefully across a lake - serene and composed on the surface, yet beneath the water, its feet are paddling frantically to maintain that illusion of effortless movement. This image perfectly encapsulates the experience of many adults with high-functioning ADHD. On the outside, they appear successful, put-together, and "normal," but internally, they're expending enormous energy to keep up this facade.


Attention Deficit Hyperactivity Disorder (ADHD) isn't just a childhood condition. For many adults, ADHD traits persist or even appear to emerge later in life (Barkley, 2015). This is particularly true for those with "high-functioning ADHD," who have managed to achieve success in various life areas despite their underlying neurodivergence. However, like our swan metaphor, the constant effort to maintain this appearance of effortless success can lead to exhaustion and burnout.



 


Understanding High-Functioning ADHD


High-functioning ADHD is not a formal diagnosis. It describes [undiagnosed] individuals who meet the criteria for ADHD yet manage to but manage to function effectively in their daily lives (Lesch, 2018). They may experience challenges with focus, time management, and impulsivity, but are able to compensate for these difficulties.


These individuals often excel in their careers, maintain relationships, and appear to have their lives "together" on the surface. They've developed impressive compensatory strategies that mask their symptoms, such as:


  • Creating highly structured environments

  • Relying heavily on reminders and organisational tools

  • Choosing careers that align with their strengths and interests

  • Developing strong support systems


However, maintaining this facade comes at a cost. The constant effort to appear "normal" can lead to burnout, anxiety, and depression. Over time, many find themselves becoming "secret flailers," struggling internally while maintaining an outward appearance of success.




A spinning top - depicting the tipping point of high-functioning ADHD in adults


The Tipping Point: When Strategies Fall Short


Major life changes or increased responsibilities can overwhelm even the most robust coping strategies. It's like adding weights to our swan - eventually, no amount of frantic paddling can keep it afloat. Many adults with ADHD report a specific life event coinciding with the onset or worsening of their symptoms, such as:


  • Starting a new job or receiving a promotion

  • Becoming a parent

  • Experiencing a significant loss or trauma

  • Entering a new romantic relationship

  • Hormonal changes (like the menopause)



Burnout and High-Functioning ADHD


For adults with high-functioning ADHD, the constant effort to maintain performance can lead to burnout. Burnout is a state of mental, physical, and emotional exhaustion caused by prolonged exposure to stress and is characterised by overwhelming exhaustion, detachment and a lack of sense of personal accomplishment (Maslach et al., 2006). It's the moment when our swan can no longer keep up the graceful appearance and starts to sink.


Adults with ADHD are three to six times more likely than their neurotypical peers to experience one or multiple burnouts (Brattberg, 2006).



The Struggle to Keep Up


The exhaustion that comes from trying to fit into a neurotypical world cannot be overstated. Many adults with ADHD describe feeling like they're constantly swimming against the current, expending enormous energy to meet societal expectations that don't align with their natural cognitive style.


This struggle often leads to internalised shame and self-doubt. Years of undiagnosed ADHD can result in a belief that one is inherently flawed or "not trying hard enough," when in reality, they're expending tremendous effort just to keep up (Pawaskar et al., 2020).





Person with "bad ass" ring - TNP depicting strengths of Adult ADHD


Recognising ADHD Strengths


Adults with ADHD succeed when they work mostly in their areas of strength, and that they can overcome many challenges at work with the right accommodations.


It's crucial to acknowledge that ADHD brains aren't deficient - they're different, and that difference can bring unique strengths. In fact, research has shown that adults with ADHD are overrepresented in high-level executive positions and entrepreneurial roles (Lerner et al., 2019). This suggests that certain ADHD traits can be advantageous in leadership roles.


  • Creativity and innovation: Many with ADHD excel at generating novel ideas and solutions (White & Shah, 2011)


  • Hyperfocus: While ADHD is often associated with difficulty focusing, many individuals with ADHD can enter states of intense concentration on tasks they find interesting or challenging. This "hyperfocus" can lead to high productivity and creative problem-solving (Sedgwick et al., 2019)


  • Cognitive flexibility: Research suggests people with ADHD may have enhanced cognitive flexibility, allowing them to adapt quickly to new situations and think outside the box (Nordby, et al., 2023)


  • Resilience: Many adults with ADHD develop strong resilience and problem-solving skills as a result of facing and overcoming challenges throughout their lives (Nordby, et al., 2023; Sedgwick et al., 2019)


  • Risk-taking: The impulsivity associated with ADHD can translate into a willingness to take risks, which can be advantageous in pursuing innovative ideas and new opportunities that have the potential for high rewards - often advantageous in entrepreneurial settings (Muûls et al., 2023, Wiklund et al., 2017)




Recognising the Signs of ADHD in Adulthood


For adults who have successfully managed their ADHD symptoms for years, recognising when these strategies are no longer effective can be challenging. Many adults with ADHD who sought diagnosis later in life experienced a gradual accumulation of symptoms, with many citing a specific life event as the tipping point that led them to seek help.


Common emerging ADHD symptoms in adulthood include:


  • Increased challenges with prioritisation, organisation and time management

  • Procrastination followed by intense periods of hyperfocus

  • Difficulty "quieting" an active mind

  • Overthinking and decision paralysis

  • Emotional intensity and heightened sensitivity to rejection

  • Relationship struggles

  • Chronic feelings of overwhelm or underachievement

  • Increased forgetfulness and difficulty completing tasks

  • Heightened sensitivity to stress

  • Sleep disturbances

  • Difficulty transitioning between tasks

  • Difficulty maintaining work performance



 


 

Burnout: The Catalyst for Discovery


For many adults with high-functioning ADHD, burnout often serves as the tipping point that leads to diagnosis, when their carefully constructed compensatory strategies fall apart. When the exhaustion of constant masking becomes overwhelming, and the coping mechanisms that once worked so well start to fail, many individuals find themselves facing a crisis point. This burnout can manifest in various ways: Lack of motivation: Activities once enjoyed, like exercise or spending time with family, may feel burdensome.


  • Chronic fatigue: Feeling constantly tired, regardless of rest.

  • Decreased performance: Difficulty focusing on tasks, even important ones.

  • Aches and Pains: Stress-related issues like headaches or stomachaches.

  • Irritability: Increased tendency to snap at others over minor issues.

  • Emotional struggles: Feelings of sadness, withdrawal, or difficulty expressing positive emotions.

  • Negativity or pessimism: Particularly about areas causing burnout.

  • Interpersonal challenges: Feeling overwhelmed by relationships, and that colleagues, partners, or children are adding to one's burden rather than offering providing enjoyment or support.


It's important to note that at least 70% of adults with ADHD also experience other mental health challenges, such as anxiety or depression, which can exacerbate burnout symptoms and hinder coping mechanisms.


Paradoxically, this challenging period can be a blessing in disguise. The breakdown of long-held coping strategies often forces individuals to seek help, leading to a diagnosis that can be both illuminating and liberating. As one client shared, "Burning out was the worst and the best thing that could have happened to me."


If you're experiencing burnout and suspect that ADHD might be an underlying factor, know that you're not alone. Many adults discover their ADHD precisely at this juncture. Seeking an assessment can be the first step towards understanding your unique neurotype and developing more sustainable strategies for thriving.




Person looking out over a winding road at from hilltop - TNP depicting path to diagnosis and treatment for adult adhd


The Path to Diagnosis and Support


For many high-functioning adults with ADHD, seeking diagnosis or support often comes after a period of burnout - when the swan can no longer keep paddling. This moment, while challenging, can also be an opportunity for self-discovery and growth.


However, despite growing awareness, many adults with ADHD face significant hurdles in recognising their condition and obtaining a diagnosis and facilitating access to effective support:


  • The "Kids Only" Myth: Many still believe ADHD only affects children

  • Outdated Symptom Descriptions: Official diagnostic symptom criteria often focus on childhood behaviours

  • Masking and Coping Strategies: Adults with undiagnosed ADHD often develop coping mechanisms that mask their symptoms.

  • Internalised Shame and Self-Blame: Years of undiagnosed ADHD can lead to deeply ingrained shame and low self-esteem.

  • Changing Symptom Presentation: ADHD symptoms can change over time and through the many seasons of our lives.

  • Varied Impact in Different Environments: ADHD symptoms may manifest differently depending on the person's job and lifestyle.



Taking Action: Understanding and Embracing Your Neurodivergent Mind


If you suspect you may have high-functioning ADHD that's becoming more problematic, consider the following steps:


  1. Educate yourself about adult ADHD and neurodiversity. See our resources section and our other adhd related articles for more learning. Additionally, staying informed about recent research can help you better understand your experiences and available treatment options.

  2. Practice mindfulness and relaxation techniques like mindfulness meditation, yoga, or simple breathing exercises, which can help to manage stress and improve focus.

  3. Seek a comprehensive assessment by a professional experienced in adult ADHD can provide clarity and direction. The assessment should include a detailed history, symptom evaluation, corroborating symptoms with someone who knows you well, and potentially neuropsychological testing (Kooij et al., 2019).

  4. Consider ADHD-informed therapy or coaching to heal from experiences in the past and develop strategies that help you to move forward and work with your brain, not against it.

  5. Explore medication options if appropriate and desired. For many adults, medication can be a game-changer when combined with other strategies. A long-term study by Lensing et al. (2016) found that adults with ADHD who received medication treatment reported significant improvements in ADHD symptoms over a 4 year period.

  6. Develop a support network to connect with others who understand your experiences. Support groups, both in-person and online, can provide a sense of community and shared understanding. Studies have shown that being a part of peer support groups can improve self-esteem and coping skills related to ADHD (Gnapp et al., 2023).

  7. Implementing lifestyle changes like adopting a balanced diet, regular exercise, good sleep hygiene and reducing one's alcohol intake can have significant positive impacts on ADHD symptoms.

  8. Reevaluate your environment: Consider whether your current job, living situation, and daily routines are supporting or hindering your ability to manage your ADHD symptoms. Sometimes, small changes in your environment can have significant impacts on your ability to function effectively.

  9. Practice self-compassion: Remember that ADHD is a neurodevelopmental condition, not a personal failing. Practising self-compassion can help reduce the stress and negative self-talk that often accompany ADHD (Beaton et al., 2022).




Conclusion


Living with high-functioning ADHD can feel like being a secret flailer - calm on the surface but struggling and chaotic underneath. The effort to appear "normal" in a world not designed for neurodivergent brains is exhausting and often unsustainable. However, recognising this struggle is the first step towards embracing your unique cognitive style and finding more authentic ways of navigating the world.


Seeking support is not admitting defeat - it's recognising that you've been swimming against the current for too long. With understanding, appropriate support, and self-acceptance, you can learn to harness your ADHD traits as strengths rather than fighting against them. The goal isn't to become a perfect swan, gliding effortlessly across the lake - it's to embrace your unique way of swimming and find environments where your paddling style is an asset, not a hidden struggle.



 

Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalised guidance.

 

WANT TO LEARN MORE?


Below are recommended resources and supportive communities exploring Adult ADHD.


ADHD Books:


ADHD 2.0 by Edward M. Hallowell, M.D. and John J. Ratey , M.D.

The ADHD Effect on Marriage by Melissa Orlov

Order from Chaos by Jaclyn Paul


Books about Neurodiversity


Different, Not Less: A Neurodivergent's Guide to Embracing Your True Self and Finding Your Happily Ever After -by Chloe Hayden

Divergent Mind: Thriving in a World That Wasn’t Designed For You - by Jenara Nerenberg


Websites with free resources on adult ADHD:



Podcasts:



Online Forums/Groups:


Reddit's ADHD Community (r/ADHD) - https://www.reddit.com/r/ADHD/

CHADD Online Support Groups - https://chadd.org/attending-a-meeting/


Social Media:


Facebook ADHD Groups (ADHD Adults, Adult ADHD Support Group, etc.)

Instagram ADHD Hashtags (#ADHD, #ADHDAdults, #ADHDLife, etc.)


 

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References


Beaton, D. M., Sirois, F., & Milne, E. (2022). The role of self-compassion in the mental health of adults with ADHD. Journal of clinical psychology, 78(12), 2497–2512. https://doi.org/10.1002/jclp.23354



Canela, C., Buadze, A., Dube, A., Eich, D., & Liebrenz, M. (2017). Skills and compensation strategies in adult ADHD - A qualitative study. PloS one, 12(9), e0184964. https://doi.org/10.1371/journal.pone.0184964


Ginapp, C. M., Greenberg, N. R., Macdonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). The experiences of adults with ADHD in interpersonal relationships and online communities: A qualitative study. SSM. Qualitative research in health, 3, 100223. https://doi.org/10.1016/j.ssmqr.2023.100223


Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., ... & Asherson, P. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56(1), 14-34. DOI: 10.1016/j.eurpsy.2018.11.001


Lensing, M. B., Zeiner, P., Sandvik, L., & Opjordsmoen, S. (2016). Four-year outcome in psychopharmacologically treated adults with attention-deficit/hyperactivity disorder: A questionnaire survey. Journal of Clinical Psychiatry, 77(4), 535-543. DOI: 10.4088/JCP.12m07714


Lerner, D.A., Verheul, I. & Thurik, R. Entrepreneurship and attention deficit/hyperactivity disorder: a large-scale study involving the clinical condition of ADHD. Small Bus Econ 53, 381–392 (2019). https://doi.org/10.1007/s11187-018-0061-1


Lesch K. P. (2018). ‘Shine bright like a diamond!’: is research on high-functioning ADHD, at last, entering the mainstream? Journal of child psychology and psychiatry, and allied disciplines, 59(3), 191–192. https://doi.org/10.1111/jcpp.12887


Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World psychiatry : official journal of the World Psychiatric Association (WPA), 15(2), 103–111. https://doi.org/10.1002/wps.20311


Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52(1), 397-422. DOI: 10.1146/annurev.psych.52.1.397


Muûls, M., & Carvajal, R. (2023). Impact of Attention Deficit Hyperactivity Disorder on Entrepreneurial Behavior: A Neurobiological Approach. Journal of Applied Cognitive Neuroscience, 4(2), e00395858. Retrieved from https://revistascientificas.cuc.edu.co/JACN/article/view/5258


Nordby, E. S., Guribye, F., Nordgreen, T., & Lundervold, A. J. (2023). Silver linings of ADHD: a thematic analysis of adults' positive experiences with living with ADHD. BMJ open, 13(10), e072052. https://doi.org/10.1136/bmjopen-2023-072052


Pawaskar, M., Fridman, M., Grebla, R., & Madhoo, M. (2020). Comparison of Quality of Life, Productivity, Functioning and Self-Esteem in Adults Diagnosed With ADHD and With Symptomatic ADHD. Journal of attention disorders, 24(1), 136–144. https://doi.org/10.1177/1087054719841129


Schubert, S. J., Rohr, M. K., Wessel, L., & Ziegelmann, J. P. (2020). Self-compassion and self-criticism in adults with attention deficit hyperactivity disorder (ADHD). Journal of Clinical Psychology, 76(7), 1308-1326.


Sedgwick JA, Merwood A, Asherson P. The positive aspects of attention deficit hyperactivity disorder: a qualitative investigation of successful adults with ADHD. Atten Defic Hyperact Disord. (2019) 11:241–53. 10.1007/s12402-018-0277-6


White, H. A., & Shah, P. (2011). Creative style and achievement in adults with attention-deficit/hyperactivity disorder. Personality and Individual Differences, 50(5), 673-677. https://doi.org/10.1016/j.paid.2010.12.015


Wiklund, J., Yu, W., Tucker, R., & Marino, L. D. (2017). ADHD, impulsivity and entrepreneurship. Journal of Business Venturing, 32(6), 627-656. https://doi.org/10.1016/j.jbusvent.2017.07.002



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