Cognitive overload can cause overwhelm in those with ADHD. Here’s how to recognise the symptoms of ADHD paralysis and ways to manage it
What is ADHD paralysis? While it’s not a medical diagnosis, nor the physical paralysis we associate with the term, people with ADHD increasingly use paralysis to describe the very real experience of cognitive overload.
It’s the brain freeze that happens when they become completely stuck, unable to make a choice, complete a task, or do anything at all.
It comes from being overwhelmed, whether that’s by a to-do list, a complicated project, mood disorders or exhaustion, and the resulting ‘paralysis’ can make their symptoms even worse.
“I’ve seen somebody I know with ADHD standing in the garden like a statue for ages, unable to go to work. Their brain is thinking through all the different choices and possibilities and consequences of a certain action, and because of that they’re just not starting what they need to do,” says Dr Helen Read, a consultant psychiatrist who worked in the NHS in the United Kingdom and now runs a private practice, The ADHD Consultancy.
Yet with treatment and behavioural strategies, it’s possible to overcome ADHD paralysis. Read on for everything you need to know.
What is ADHD paralysis?
ADHD paralysis is when people with the disorder feel frozen and unable to act.
“They know they should do something, but they can’t garner the motivation to do it, even though they know there is going to be a consequence for not doing it,” says Dr Mike Smith, a consultant psychiatrist and clinical lead of the Leeds NHS Adult ADHD service.
This is because, in people with ADHD, there is a disorder in what is known as their executive function, or the decision-making, planning and execution of a particular task.
“This kind of paralysis, or freeze or whatever you want to call it, is just an expression of difficulties with what we call the executive function in the prefrontal lobe, which allows us to start, implement and complete activities,” says Dr Samuele Cortese, a professor of child and adolescent psychiatry at the University of Southampton, whose research focuses on ADHD.
Causes of ADHD paralysis
Experts say that miscommunication between different networks in the brain is what is most likely to be causing the experience of paralysis.
“Individual areas of the brain are different in people with ADHD in terms of size and function, but also there is a difference in connectivity. The frontal lobe, or executive network, allows us to plan and select the right choice.
“The default mode is more focused on daydreaming and introspection. With ADHD it seems like the default mode network interferes with the functioning of the executive network, distracting it from fulfilling a task,” says Cortese.
ADHD paralysis can also be brought on by stressful work environments, with some research showing that working from home can be helpful.
Types of ADHD paralysis
Mental paralysis
Mental paralysis is when people’s brains become overwhelmed by competing thoughts, emotions or sensory overload, which may make it challenging for them to talk, move, work or communicate what is going on in their minds.
Task paralysis
A lengthy to-do list and a lack of motivation may bring on an inability to get going with a particular project or task.
“When something needs to be done, the more recently evolved part of your brain establishes how important that task is. But if you have lower levels of dopamine, like many people with ADHD, something has to be labelled as much more important for them to get going and do it, while medication can increase dopamine and help with that motivation,” explains Smith.
Choice paralysis
Similarly, when faced with a choice or decision, people with ADHD may find it hard to prioritise or choose, and end up overthinking the situation and doing nothing.
“What you see with people with ADHD is an aversion to delay. So if you ask a person with ADHD if they would like an ice cream now or a super car tomorrow, most wouldn’t be able to delay and would choose the ice cream today. Needing that reward immediately can affect the decision-making process,” says Cortese.
Symptoms of ADHD paralysis
Brain fog
This may feel like an inability to focus, as well as being forgetful, absent-minded and sleepy.
Exhaustion
This comes from being overwhelmed mentally. This may also manifest as a headache or insomnia.
Executive dysfunction
This shows up as problems with planning, meeting goals, controlling emotions and prioritising work and chores.
Poor time management
Paralysis might lead people to be late, miss meetings, and not anticipate how long things will take. “Lots of experiments have shown that ADHD people don’t have a good sense of time, they think it is both longer and shorter than it is,” Cortese notes.
Emotional volatility
ADHD often goes along with emotional dysregulation. “We sometimes call this rejection sensitivity dysphoria, but people with ADHD are often very sensitive to rejection, teasing and criticism – the slightest thing can knock them into the abyss. In adults, the physical hyperactive symptoms of ADHD tend to decrease with the maturing brain, but what can stay and become worse are the problems of attention and emotional dysregulation,” explains Cortese.
“We know that medication helps less with emotional problems compared to other symptoms, so we need more effective treatments for that.”
Social isolation
ADHD paralysis can lead the person with ADHD to retreat from social interaction, which might already be a problem in their lives. “Some people with ADHD do have a co-occurrence of autism spectrum disorder which can impact on social relationships,” Cortese adds.
How does ADHD paralysis differ from procrastination?
Whereas paralysis is about being stuck and unable to do anything, procrastination is common for those with ADHD as well and is usually about leaving things to the last minute in order to get the motivation to do it.
“For example, say they’re doing a PhD, they might spend 11 months doing the research, and leave all the writing to the very last minute. They’re looking for the last-minute panic or hyperfocus to force them to complete a task,” says Read.
Overcoming ADHD paralysis
Getting a diagnosis and medication from a specialist doctor is usually the best way to overcome ADHD paralysis, However, many behavioural strategies can help.
Write everything down
Keeping a daily list of obligations, meetings, work tasks and the like can help with remembering things and being organised. Once written down, organise them into different levels of importance. Check back to the list regularly and tick off each completed task.
Structure and plan in advance for writing tasks
Read says many of her clients with ADHD struggle with tasks that involve language. “If you structure and plan as much as you can to set the template in advance, then it’s easier to do the research and write into the template,” she says.
Focus on small easy wins and rewards
If you’ve got a big, complex project to complete, divide it up into smaller, more achievable tasks. Write them down, do them in turn and take a break between each one. Reward yourself with a small treat when you complete each one. Be careful not to take on more work than you can manage, as this may lead to stress and more paralysis.
Enjoy socialising, but schedule regular downtime for decision-making
“Socialising with others may be fun, but is often hard work. People with ADHD do need quite a lot of downtime to recharge,” explains Read. Use that downtime to connect to your intuition when it comes to any decisions.
Try the Pomodoro technique
This simple technique was invented in Italy in the late 1980s and is transformative for many. Set a timer for 25 minutes, work without being distracted, and then take a five-minute break. Every four Pomodoros take a 15-minute break. You can also use the Pomofocus website.
Take regular movement breaks
When the brain gets tired, stop what you’re doing and move. Go for a short walk, do 10 jumping jacks, and take a turn around the garden to give your brain a short rest. Do a full workout if you feel like it. Elevating your heart rate can boost dopamine and motivation and relieve stress.
Try cognitive behavioural therapy (CBT)
The challenges of ADHD can lead to a lot of negative thinking. CBT that is specially adapted for ADHD can help people reframe those thoughts and cope with emotional dysregulation.
Treatment for ADHD paralysis
Medication is usually very effective at treating ADHD paralysis and core symptoms like inattention and impulsivity.
