Unmasked: Hidden Exhaustion Of ADHD – When Rest Doesn’t Help

For many people, tiredness is simple: too little sleep means too little energy. Yet, for individuals with ADHD, the story is far more complex: hidden exhaustion of ADHD becomes a constant companion—one that is often invisible and misunderstood, yet profoundly affects daily functioning, work performance, and mental health.

Sleep alone doesn’t solve the tiredness neurodivergent individuals with ADHD experience. Here, we will unpack one key contributor: sensory sensitivity, and it’s often overlooked relationship with ADHD and stimulant medication.

ADHD and Exhaustion: More Than Just Fatigue

Exhaustion in ADHD can be broken down into three interlinked components:

1. Mental fatigue
2. Sleep issues
3. Functional impairment

One of the primary yet under-acknowledged contributors to this exhaustion is sensory sensitivity. People with ADHD often experience the world more intensely—sounds, lights, smells, and textures can all overwhelm the nervous system. While not formally included in diagnostic criteria, sensory issues are frequently reported and backed by research.

Sensory Sensitivity in ADHD: What the Research Shows

A comprehensive systematic review and meta-analysis of 30 studies involving 5,374 participants confirmed that individuals with ADHD demonstrate significantly more sensory processing atypicalities—including hypersensitivity, sensory avoidance, hyposensitivity, and sensory seeking—compared to neurotypical controls (Raimondo et al., 2024). This confirms that sensory challenges are intrinsic to ADHD, not just side effects of lifestyle or medication.

Further studies reinforce this:

1. A 2017 study demonstrated that children with ADHD show altered tactile adaptation, even off medication, suggesting a baseline sensory processing difference (Mangeot et al., 2017).
2. A large-scale study of 138 adolescents found that individuals with ADHD had heightened sensory sensitivity across modalities—including touch, sound, and light (Bijlenga et al., 2017).

Medication and Sensory Overload: An Uncomfortable Truth

Stimulant medications like methylphenidate (Ritalin, Concerta, Medikinet) and amphetamines increase dopamine and norepinephrine—neurotransmitters vital for attention and executive function. While these medications improve focus, they also increase arousal and alertness, which may intensify sensory awareness.

Several small studies and anecdotal reports suggest a connection between ADHD medication and increased sensory sensitivity:

1. A 2009 case report documented two children who developed new tactile behaviours (e.g., lip biting, nail biting) after starting methylphenidate. Reducing the dose resolved the behaviours (Mishra & Mullick, 2009).
2. Users on online platforms such as Reddit often describe becoming “more overstimulated” or developing photophobia (light sensitivity) after beginning stimulants.
3. Case studies propose that increased pupil dilation and general arousal caused by stimulants might heighten sensitivity to light, sound, and touch—particularly in those already predisposed.

So How Does This Link to ADHD Exhaustion?

1. Sensory Sensitivity Predicts Work Fatigue

A clinical study comparing 69 adults with ADHD to 52 controls used the Adolescent/Adult Sensory Profile and sleep assessments. Results showed that:

1. Individuals with ADHD had significantly higher sensory sensitivity, poorer sleep quality, and reduced work performance.
2. Sensory sensitivity explained 10.9% of the variance in work performance, while sleep quality explained 22% (Bijlenga et al., 2017).

This means that sensory overload directly impacts professional functioning and contributes to burnout.

2. Sensory Modulation and Sleep Disruption

In a study involving children aged 8–11:

1. 86% of those with both ADHD and sensory processing issues had sleep problems.
2. In contrast, only 30.8% of ADHD children without sensory issues and 16.7% of neurotypical controls experienced sleep problems (Reynolds & Lane, 2009).

Sensory challenges significantly worsen sleep, fuelling daily fatigue.

3. Cognitive Fatigue from Continuous Processing

Even without medication, ADHD is associated with chronic mental fatigue due to:

1. Constantly filtering out irrelevant sensory stimuli.
2. Performing executive function tasks like planning, prioritising, and task-switching.
3. Continuous emotional self-regulation and decision-making.

This type of fatigue is mentally draining, and when compounded by sensory overload, it leads to reduced emotional regulation, increased impulsivity, poor sleep quality, lower productivity, and rising anxiety or depression (Dodson, 2020).

Medication Can Help—but the Environment Still Matters

Stimulant medication is often crucial in ADHD treatment, but it’s not a silver bullet. If your environment is overwhelming, medication might sharpen your focus—but also heighten sensory discomfort. Without adequate environmental support, you remain at risk for burnout.

What Can You Do?

Understanding the invisible exhaustion caused by sensory overload is the first step. Addressing it requires more than sleep and medication—it demands a supportive, adaptive environment that reduces sensory load and respects neurodivergent needs.

That’s why we created our latest course:

Therapy Unmasked: A Practitioner’s Guide to Working with Neurodivergent Clients

This course equips professionals to:

• Recognise sensory sensitivity as a core challenge in ADHD.
• Adapt therapeutic and workspaces to reduce sensory overload.
• Improve client outcomes through neurodiversity-affirming practices.

Whether you’re a therapist, educator, or support professional, this course will help you create a space where neurodivergent individuals don’t have to mask, overexert, or burn out just to get support.

Let’s care together—for neurodivergent minds, environments matter.

References:

• Bijlenga, D., Vollebregt, M. A., Kooij, J. J. S. & Arns, M. (2017). The role of the circadian system in the etiology and pathophysiology of ADHD: Time to redefine ADHD? Attention Deficit and Hyperactivity Disorders, 9(3), pp. 123–134.
• Dodson, W. (2020). ADHD and Mental Fatigue. ADDitude Magazine. [Online] Available at: https://www.additudemag.com/adhd-and-mental-fatigue/
• Mangeot, S. D., Miller, L. J., McIntosh, D. N., McGrath-Clarke, J., Hagerman, R. J. & Goldson, E. (2017). Sensory modulation dysfunction in children with attention-deficit–hyperactivity disorder. Developmental Medicine & Child Neurology, 43(6), pp. 399–406.
• Mishra, A. & Mullick, M. S. I. (2009). Methylphenidate and its effect on tactile sensitivity: A case report. Journal of Indian Association for Child and Adolescent Mental Health, 5(3), pp. 120–123.
• Raimondo, L., Langen, M., Staal, W. G., et al. (2024). Sensory processing in attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Journal of Neurodevelopmental Disorders, 16(1), 18.
• Reynolds, S. & Lane, S. J. (2009). Sensory over-responsivity and ADHD: Differentiating symptoms and co-occurrence. American Journal of Occupational Therapy, 63(3), pp. 320–327.