A range of lifestyle and environmental triggers can worsen this neurodevelopmental disorder, experts say. The good news is that most can be managed.
From forgotten appointments and lost keys to emotional ups and downs, poor sleep and chronic procrastination, living with ADHD can feel like being on a rollercoaster with no end in sight.
While these daily struggles are frustrating, they rarely happen in isolation, and many things can make them worse. Research shows that those with ADHD often live with co-occurring mental health conditions such as anxiety and depression, as well as other neurodevelopmental disorders like autism or dyslexia. There’s also a higher risk of addiction, which can further intensify symptoms.
Medication can be transformative – but it doesn’t work for everyone, and the wrong dose can be counterproductive.
Yet alongside these more clinical drivers, experts point to a range of lifestyle and environmental triggers that can quietly make ADHD worse: inconsistent routines, poor sleep and diet, digital overload, even hormonal shifts in perimenopause.
The good news is that most of these are within your control.
“I commonly use this idea of being on and off track. Because ADHD is a disorder of dysregulation, many things can knock you off that track,” says Dr James Kustow, a consultant psychiatrist specialising in ADHD and author of How to Thrive with Adult ADHD.
Here’s what can make ADHD worse – and what might help.
Lack of routine and structure
Because of executive dysfunction struggles, routine is especially important for those with ADHD.
“ADHD can feel like you’re a ship being blown around because every day is like Groundhog Day. You don’t have a great sense of the past or future, so you need things in the present to anchor you, to make you feel safe and present, to stabilise the ship,” says Dr Kustow.
Prioritising and decision making are often difficult, so without any external structure, there is a danger of drift or not being productive or efficient. “Then you might miss deadlines, or not pay your bills, and suddenly you’re in firefighting mode and all sense of balance goes out of the window.”
What to do: Build consistency into your week with anchor points like a regular hobby, work periods or exercise class, with some flexibility for variation and novelty.
Make sure there are fixed, scheduled activities (eg: “Monday is yoga night”, “take pills after brushing teeth”) and habits that repeat on a rolling basis. Plan out your days into blocks, making sure to allow time for meals and meal prep, morning and evening routines, work, social time and downtime.
Poor sleep
Struggling with sleep is a bit of a hallmark of ADHD, and one of the “signs we look for in assessments”, says Dr Fleur-Michelle Coiffat, a consultant clinical psychologist who specialises in neurodiversity.
ADHD-ers often have disrupted circadian rhythms, struggling to get to sleep or waking at odd hours. Poor sleep also worsens ADHD symptoms like focus, anxiety and impulsivity.
ADHD is often called a “dopamine disorder”. Lower levels of this neurotransmitter drive people to seek stimulation, like scrolling social media or watching TV late, which keeps the mind switched on.
What to do: Dr Coiffat recommends a pre-sleep routine to relax the mind and body. “Put down your devices, dim the lighting, and do calm activities like a bath, reading or gentle stretches.”
She also suggests exercise to counter restlessness. “If you don’t burn off energy during the day, it can make you restless at night – including hyperactivity of the mind,” she adds.
Journaling can help. “Get your thoughts down on paper, but limit it to 10 minutes, so you don’t start to get anxious,” Cioffat says. Meditation may also help quieten and slow down the mind.
A negative mindset
From comments like “you’re lazy”, “disorganised” and “unmotivated”, people with ADHD have often had a lifetime of absorbing negative messages and as a result often struggle with shame and lack of self-confidence.
“This can lead to withdrawal, people might think nobody likes them, or they’ll say the wrong thing, or that they don’t fit in or can’t manage a task. But social interaction with trusted friends, family and colleagues can help with these negative thoughts,” Coiffat says.
Emotional dysregulation is often a key marker of ADHD, and many experts talk about “rejection sensitivity dysphoria”, where people are extremely sensitive to criticism and perceived rejection.
What to do: “Communication is important; it might be as simple as asking someone to adjust how they give feedback or how they respond to emails,” Coiffat says.
Kustow advises nurturing a growth, rather than a fixed, mindset.
“When faced with a setback, think about what you can learn from it, and how adversity makes you stronger. Also, it’s important to address the self-esteem challenges of ADHD with support scaffolds – spiritual, social, family and therapeutic."
Poor diet
Many ADHD-ers reach for sugar, caffeine and energy drinks as well as processed foods to give them a short-term hit. This can lead to issues like overeating or skipping meals, which is why they have higher rates of obesity and binge-eating disorder.
“Reaching for sugar hits can be addictive and get you into a vicious cycle,” Coiffat says. “If your blood sugar levels are spiking, that will heighten issues with attention, focus and restlessness. A lot of people with ADHD, and I do this myself, are often so focused on something or using all their brain capacity just to get through the day that they forget to eat, which also leads to a crash.”
What to do: Keep blood sugar consistent by eating regularly and healthily. Try to keep simple snacks like a handful of nuts on hand. Avoid sugar and simple carbohydrates like white flour and rice, and include sufficient protein in every meal, as protein helps stabilise blood sugar. Get “hits” from other sources like live music, exercise, and cold water swimming.
An over-stimulating environment
People with ADHD can thrive on a certain degree of novelty and stimulation, as monotonous tasks can cause shutdown, zoning out or restlessness. However, it’s a fine balance as chronic stress and anxiety can also intensify ADHD symptoms, leading to potential increased impulsivity, difficulty concentrating, problems with emotional regulation, performance at work and burnout.
People can vary quite widely here. Many might struggle with a nine-to-five, desk-based job in an open-plan office with a lot of potential for noise and distractibility. However, for others, the noise and routine could be helpful.
“There can be a struggle to get in for 9am because of their sleep rhythms, then there is the sensory overload of a journey on public transport in rush hour. The monotony of a desk job that involves little interaction can exacerbate physical and mental restlessness,” Kustow says.
However, many with ADHD are also on the autistic spectrum. “I have a patient who loves archiving, because it’s just bringing order into things, but that would be extremely boring for someone who doesn’t have that combination,” Kustow adds.
Social media and excessive screen use are often a problem, as ADHD-ers crave stimulation and the dopamine hits of excessive scrolling, but this can also exacerbate problems with concentration.
What to do: In the workplace, it’s important to limit screen time and schedule regular screen and meal breaks, as well as time to move around and get outside.
“Jobs that involve creativity, project work, variety and problem solving can be more suitable,” Kustow says. But take time to understand your individual needs.
Toxins and environmental stressors
This is an emerging area, but people with ADHD may be more likely to have allergies, autoimmune issues and inflammation, Kustow says. “Some have more sensitive immune systems, with hypermobility, allergies or chronic illness.”
He highlights mould. “If you’re in a mouldy home and struggling with brain function, they may be connected. Some evidence is anecdotal, but toxins may trigger inflammation in sensitive individuals.”
What to do: If you are someone with ADHD who suffers from allergies and has poor immunity, it might be worth trying to reduce toxins in the areas that you have control over. You can gradually buy less toxic versions of cleaning products, both for your body and home, makeup, and natural, pesticide-free foods.
Hormonal shifts
Hormonal shifts can make ADHD worse, and also “unmask” previously undiagnosed ADHD. Perimenopausal women are now one of the largest groups seeking diagnosis.
“During perimenopause, estrogen levels become dysregulated and start going down, which also reduces dopamine,” Kustow says. “A woman with ADHD in their 40s may notice that their ADHD might worsen, and they might need higher doses of medication or HRT [hormone replacement therapy]. Then there are the people who never got a diagnosis because they just about managed, but then suddenly it gets worse because of hormonal shifts and their ADHD is unmasked.”
What to do: Adjusting ADHD medication can be helpful, as can HRT. Some doctors might prescribe an antidepressant.
Does ADHD get worse with age?
ADHD is a neurodevelopmental condition, so it doesn’t fundamentally change with age, although the way it manifests can evolve as a response to life events and physical changes.
Children are more likely to be hyperactive than adults, and adults may have more issues with time management and organisation.
“In a minority, it can improve and resolve, but most will be stable but find that symptoms may get aggravated at different points in life, as demands change over time, including increasing life responsibilities, hormonal shifts, accumulated stress and physical decline,” Kustow says.
“The demands of retirement are quite different from sitting at a desk doing complex calculations, for example, and symptoms may respond accordingly.”
- Dr James Kustow is the author of ‘How to Thrive with Adult ADHD: 7 Pillars for Focus, Productivity and Balance’