A pink-haired character looking sad, above text reads 'ADHD & CHRONIC FATIGUE SYNDROME' indicating the struggle of dealing with both conditions.

Unraveling the Link Between ADHD and Chronic Fatigue

Chronic fatigue is a significant issue for many with ADHD, impacting daily functioning and quality of life. This fatigue stems from the continuous mental effort required to manage ADHD symptoms, often leading to a quicker depletion of energy reserves. The 'spoon theory' is useful here, illustrating how people with ADHD must judiciously use their limited energy 'spoons' throughout the day. Effective management includes prioritizing tasks, incorporating rest, and establishing a consistent sleep routine. Understanding this dynamic is crucial for developing coping strategies that address both ADHD and its associated fatigue.

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Written by

Tayler Hackett

TMAC Editorial Manager & Trainee Psychotherapist

Reviewed by

Lisa Batten

Clinical Researcher, Writer, and Consultant
In this Article

Reviewed by

Lisa Batten

Clinical Researcher, Writer, and Consultant
A word from our expert

Fatigue is a common symptom of attention deficit hyperactivity disorder (ADHD). People with ADHD may experience fatigue, burnout, and brain fog ADHD burnout can include feelings of overwhelm, exhaustion, and stress. It can also lead to reduced productivity, a sense of hopelessness, and difficulty regulating emotions. Research suggests that people with ADHD may be more prone to chronic fatigue. According to a 2021 study, up to 93% of adults with ADHD experience burnout symptoms, compared to 30% of the general population.

Understanding ADHD-Related Chronic Fatigue

ADHD and Chronic Fatigue are intertwined, with ADHD symptoms often exacerbating feelings of constant tiredness. 

This is due to the persistent neurological effort required to manage ADHD's cognitive demands, leading to overwhelming fatigue. 

Tailored management strategies can significantly alleviate these symptoms.

The Secret To Managing ADHD & Chronic Fatigue Syndrome

While the idea of Chronic Fatigue Syndrome (CFS) existing alongside Attention Deficit Hyperactivity Disorder (ADHD) sounds like a paradox, it's more common than you think. And the secret behind getting the balance right? Spoons. 🥄

  • The 'spoon theory' is a metaphor for energy management, comparing our daily energy to a finite number of spoons that are used in every activity, big and small.
  • People with Chronic Fatigue Syndrome (CFS) and ADHD may start with fewer spoons, meaning they exhaust their energy faster on routine tasks, necessitating careful planning to avoid running out.
  • Pacing is a strategy to get the most out of the energy we do have by balancing activity and rest.
  • On bad days, where ADHD and CFS symptoms surge, simple strategies like using a bed desk, leaning on social support, choosing healthy ready-made meals, and adjusting your sleep routine can make all the difference.

Before receiving my diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), I was already wrestling with the ups and downs of Chronic Fatigue Syndrome (CFS). The moment I got my ADHD diagnosis, I began to ask myself - could my chronic fatigue actually be a symptom of ADHD? 😳Was it just adult ADHD all along, masquerading as CFS? 

A pink-haired character with a speech bubble 'ADHD & CFS' looks fatigued next to the text 'Did you know that many people with ADHD also live with Chronic Fatigue Syndrome (CFS)?

After some in-depth research, I learned that the overlap between ADHD symptoms and chronic fatigue can make the two difficult to differentiate. They share quite a few symptoms, from difficulty in maintaining focus and irritability to mental fatigue. And let's not forget the daily life struggles of sleep issues, making it hard to discern if it's ADHD-related fatigue or something else entirely. 🤷

Then, a friend of mine with CFS told me about the spoon theory, and it was a lightbulb moment for understanding and managing my symptoms. 💡This simple yet impactful metaphor drastically changed how I approach my routine demands, specifically when coping with the cognitive load that comes from having both ADHD and CFS. The theory has become a pivotal part of how I manage my energy levels and effectively manage my ADHD. 🤩

How ADHD and CFS Interact

It might go without saying, but living with Attention Deficit Hyperactivity Disorder (ADHD) and Chronic Fatigue Syndrome (CFS) at the same time is exhausting. 😩

While ADHD symptoms often involve difficulty focusing, impulsivity, and hyperactivity, CFS throws in debilitating fatigue, sleep issues, and often, brain fog. 🧠When you have ADHD and CFS, these issues have a terrible habit of stacking up against each other, which quickly leads to burnout. 🔥

For instance, many adults with ADHD struggle with sleep difficulties, thanks to racing thoughts and general inability to switch off. Add CFS to the mix, and you're now dealing with not just a lack of sleep but an elevated risk of sleep deprivation. Medications often prescribed for ADHD can also lead to insomnia, potentially worsening CFS symptoms like exhaustion. Also, the overwhelm of managing both conditions can affect working memory and executive functioning, keeping us stuck in a never-ending loop of brain fog. 🤯

Image of two characters holding 'spoons' with text 'Some people with CFS use spoons to explain how their energy levels work – and it can be applied to ADHD, too!'
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Introduction to Spoon Theory

As odd as it sounds, the spoon theory is a metaphor that many people with chronic or invisible conditions such as CFS find helpful in understanding, explaining, and managing energy levels. 

The 'spoon theory' was first articulated by Christine Miserandino, who lives with lupus. After being asked what life was like with her chronic illness by a friend over some food, Christine ingeniously grabbed a bunch of spoons 🥄 to craft an unforgettable metaphor about the day-to-day struggles she faces.

Visual explanation of 'Spoon Theory' with the character holding a sign saying 'Spoon Theory = Energy' and the text ' "Spoon Theory" is a metaphor that uses spoons to represent how much energy we use each day.

The gist of the metaphor is this: every morning, we begin the day with a set number of 'spoons' - a certain amount of physical and mental energy. However, people living with certain physical conditions or mental health disorders may begin the day with fewer spoons than most. Each activity costs us a spoon - and most importantly, for those with a chronic illness, seemingly small activities like taking a shower could cost us more than one spoon. 

Drawing of a smiling pink-haired character on the phone, cooking, and feeding a cat, with an indication of 'spoons' being used for each task. Text states 'Every activity costs you a number of spoons...

So, not only do we tend to start off the day with less energy compared to most people, but specific tasks can drain us more, too. And unlike those endless cups of coffee we wish we had, spoons are limited and only come back through rest. But how does it work in the context of ADHD and chronic fatigue? 

Cartoon of a weary pink-haired character with a row of 'spoons' and a cat, accompanied by text '...but if you've got ADHD or CFS, it can feel like you start the day with fewer "spoons". Meaning you have to be more mindful about how you use your energy.'

Because of the many symptoms associated with CFS, like brain fog and sleep issues, we often find that we run out of spoons quicker than most. When we consider the mental load of managing ADHD symptoms, it begins to make sense why CFS and ADHD can exacerbate one another.

What do you do if you run out of spoons? You could borrow from tomorrow's stash, but that puts you at a deficit, exacerbating symptoms and making the following day even more challenging to manage. 📉Being aware of this energy allocation helps us be intentional about our activities and the cognitive load we take on, prioritizing what needs to be done today while leaving less crucial tasks for days when we might have a few extra spoons. 

This habit is often referred to as ‘pacing’ - which is a common holistic treatment approach used in occupational therapy for many chronic conditions, including CFS. So, how can we utilize pacing when trying to manage CFS alongside ADHD? 

Pacing For Managing Chronic Fatigue & ADHD

Think of pacing as your personalized energy-saving mode. 📱Like that handy battery-saving mode on your phone, the goal of pacing is to dodge that ever-so-familiar 'push-and-crash' cycle by helping you retain as much energy as possible between rest periods. An effective pacing strategy allows you to get the most out of the energy and 'good' days while preventing or reducing the intensity of the bad ones.

Pacing is about harmony - mixing activity with rest, setting realistic goals, and sidestepping the exhaustion trap. ⚖️ The tricky part? What feels like 'overexertion' can shift daily, so it's important to reassess as you go.

Image of a pink-haired character working on a laptop and another relaxing with a cat, with text 'To do this, some people use a strategy called pacing. It involves carefully balancing activities with chill-out time.'

The Fundamentals of Pacing 

Aggressive Rest

Yup, you read that right! This is a moment where you lie still, eyes closed, completely free from distractions like music or your phone. It might sound boring, but the intention is to remove all forms of stimulation. This can be tricky for an overactive ADHD brain - so you might find it helpful to slightly adjust this technique by listening to something like white noise. 🎧

Preemptive Rest

Got a busy week ahead? Schedule preemptive rest, which involves resting before an energy-draining task or day. For example, if I have a party to go to, I'll schedule an hour's power nap before I go out that evening. 😴It prevents me from flagging early and enables me to maintain my social life. 

Small Bursts of Activity

Break tasks into bite-sized pieces and start with manageable portions. As you gauge your tolerance, feel free to level up - but keep it gradual. This allows you to 'dip your toe in' and calculate your energy levels for that day accordingly. 

No Rush Zone

Where possible, turn your day into a 'no rush zone.' Allow yourself plenty of time to tackle activities without the frantic energy that usually leads to a crash. 📉Some people plan ahead on which days they will allow a 'slow' day, where they're still productive but at a slower pace.

Strategic Rest Stops

Scheduling short breaks between tasks to keep your energy levels in check can help you get more out of life. These could be decided upon as you go, or planned ahead. For example, when I go away on a city break, I plan my itinerary accordingly, ensuring gaps between going to museums, dinner reservations, or tours that allow me to rest both physically and mentally. Before I got into the habit of doing this, a long weekend trip would take my body a week to recover from - but now, I come back feeling like I've actually had some time off. 😂

Pink-haired character appears overwhelmed beside a to-do list, with the text 'Sometimes, this doesn’t work – and our symptoms can "flare up". When this happens, we have to find ways to take things back to basics.' and suggests 'Let’s take a shower and go to bed early instead!'

Commitment Control

The power of 'no' is magical. ✨Overcommitting is a one-way ticket to burnout, so be careful with what - and who - you say yes to. If you realistically know that you can't manage to have evening plans two nights in a row, figure out which you can reschedule and who you can say no to. Although it might be frustrating to turn down fun plans, trying to stagger them out where possible is much more sustainable and satisfying. 

Sleep Routine

According to the Sleep Health Foundation, it’s common for adults with CFS to get twelve hours of sleep and still struggle with tiredness and fatigue throughout the day. To combat this exhaustion, consider adding an afternoon nap to your routine, either as a bonus or as part of your 8-9 hours of total sleep. This tweak could allow you to healthily add more sleep to your routine and make day-to-day tasks more manageable.

Body Talk

If you find specific activities require a lot of downtime and rest afterward, get curious about why this might be. For example, if catching an early flight can take you a few days to recover, consider the benefits of paying a little extra for a slightly later one. 

Smart Planning

Got some juice in the tank? Use those high-energy periods to tackle the more demanding tasks. It's all about optimizing your day to play to your strengths. But if you can, resist the urge to hyperfocus - this can lead to burning out without realizing it, which can kick the cycle off all over again. Try setting timers for breaks throughout the day, allowing you to get the most done without falling back into the trap. ⌛

Rule Out Any Underlying Health Conditions

It’s important to check there’s not an underlying medical condition behind your ADHD fatigue - an undiagnosed medical condition such as sleep apnea, anemia, diabetes, hypothyroidism or a mental health condition such as depression or anxiety can mimic the symptoms of CFS. Sometimes, due to poor health monitoring with adult ADHD, these symptoms can get missed. However, when these conditions receive the correct  treatment, excessive tiredness might be relieved and make it easier to pace your energy more effectively.     

Managing Bad Days

Sometimes, despite your best efforts, you might be in a 'flare-up,' when your symptoms temporarily worsen. Whether it's sparked by stress, a sudden illness, or just seems to come out of the blue, these rough days can involve both ADHD and CFS symptoms making a grand entrance all at once. 😬

When this happens, even the most routine demands of daily life can feel incredibly overwhelming and exhausting. So, what's the game plan for such days? Let me share which coping strategies work for me and might help you, too. 🤗

  • Consider a 'bed' desk, a collapsible tray designed to fit your laptop, allowing you to work while sitting in bed. It's the perfect solution for those days when the deadlines are looming, and you need to focus, but your body is begging for rest.
  • Be proactive about your medication - especially if you've been prescribed stimulants as part of your treatment plan. Skipping these can cause even more of an energy crash and worsen your ADHD symptoms, even in the short term. Use mail-order services or ask a friend to get your prescription.
  • While exercise helps prevent fatigue, during a symptom flare-up, we often have an elevated risk of exercise intolerance and something called 'post-exertional malaise.' Instead, light stretching can do wonders for both body aches and mental exhaustion, especially if you have to rest for long periods.
  • Enlist friends or family for routine demands and daily tasks like grocery shopping or walking the dog. It can feel hard to ask for help, but social support has a pivotal role in helping us get back on our feet sooner. It can be helpful to agree with specific loved ones about what they can help with during these periods - which may help you feel more comfortable about asking for support. 💕
  • Navigating a flare-up with ADHD and fatigue can make fast food tempting, but remember, diet plays a pivotal role in how you feel. Many food delivery services now offer groceries with ready-made healthy options. When possible, stock up on non-perishable meals and nutritional snacks. As diet impacts both energy levels and ADHD symptoms, opting for these can help speed up the recovery process.
  • People with ADHD often experience difficulty falling asleep, and poor sleep can exacerbate both ADHD and fatigue symptoms. Having a 'go-to' sleep routine for flare-ups can also be helpful - you might find your body requires a few extra hours of sleep a night, which might mean adjusting the time you begin to wind down for the night during these episodes.
Illustration of a pink-haired character balancing on a tightrope between spheres labeled 'THINGS I WANT TO DO' and 'HONORING MY NEEDS.' Text reads 'Many of us try to mask our ADHD by overcompensating... But we need to learn to pace ourselves and honor our body when it needs rest.'

Key Takeaways

Attention deficit hyperactivity disorder (ADHD) and chronic fatigue syndrome (CFS) can co-exist and make each other worse. The fatigue and low motivation associated with both conditions can be overwhelming - so be kind to your brain and body!

Spoon Theory is a helpful metaphor for managing energy and focus in ADHD and CFS. Think of your energy as a limited number of 'spoons' you can use throughout the day, and plan accordingly.

Practical tips for pacing to prevent burnout include:

  • maintaining a consistent sleep routine
  • setting manageable goals
  • scheduling rest
  • using prescribed stimulants cautiously.

When facing a flare-up of ADHD and fatigue symptoms, consider strategies to quicken your recovery like:

  • stocking up on easy meals
  • being proactive about medication
  • opting for light stretching over intense exercise
  • seeking social support
  • working from a bed desk
  • making smart food choices
  • fine-tuning a sleep routine

The brain and body responds to gradual, sustainable change best, so take it slow. Many of us with adult ADHD have a habit of trying to do everything all at once, which can make us vulnerable to fatigue and is a one-way ticket to burnout. Slow and steady wins the race! 😉

What's Next? 

Want to dive deeper into the complex relationship between ADHD and issues like fatigue, sleep, and energy levels? We've got you covered!

How ADHD Symptoms Can Lead To Tiredness

Why Is It So Hard To Wake Up With ADHD?

When ADHD Fatigue Becomes Burnout

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Frequently Asked Questions (FAQs)

Can ADHD Cause Chronic Fatigue?

Yes, ADHD can indeed contribute to chronic fatigue. Many adults with ADHD experience fatigue as a significant symptom, though it's often overshadowed by more commonly recognized symptoms such as inattention, hyperactivity, and impulsivity. The cognitive load of managing everyday tasks, poor health monitoring, and sleep difficulties can lead to persistent tiredness. Furthermore, many prescribed stimulants for ADHD, while helpful in managing focus and hyperactivity, can disrupt sleep patterns, contributing to fatigue.

Can You Be Extremely Tired With ADHD?

Absolutely. Adults with ADHD frequently report extreme tiredness, which goes beyond the normal ebbs and flows of energy levels experienced by the general population. This fatigue can be attributed to various factors, including the intense effort required to manage symptoms, the cognitive load associated with ADHD and sleep difficulties often experienced by those with the disorder. Moreover, ADHD-related conditions such as anxiety and depression can further exacerbate feelings of exhaustion.

Do ADHD Symptoms Get Worse With Tiredness?

Fatigue can exacerbate ADHD symptoms, creating a challenging cycle where tiredness worsens symptoms, and symptoms, in turn, increase fatigue. When an individual with ADHD is tired, their ability to manage symptoms effectively can diminish, leading to increased difficulties with attention, impulsivity, and hyperactivity. Sleep difficulties common in ADHD further compound this issue, making it harder to maintain focus and emotional regulation. Managing tiredness is a crucial part of effectively managing ADHD symptoms.

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