Ever wonder why you can't do mindfulness which suggests you follow your breath and you feel pressure to quiet your mind?  What if you learned it's part of ADHD that our mind is rarely quiet? And what if you just watched your mind instead of trying to change it?

The Default Mode Network (DMN) plays a critical role in understanding ADHD and can inform how mindfulness practices are taught to clients. In ADHD, the DMN—responsible for self-referential thinking, mind-wandering, and introspection—tends to be overactive and insufficiently suppressed during tasks that require focused attention. This can lead to frequent, intrusive thoughts and difficulty maintaining focus.

When teaching mindfulness to clients with ADHD, it's essential to adapt the approach to accommodate this DMN overactivity:

1. Pair Mindfulness of Breath with Mindfulness of Thoughts

• Acknowledging the Overactive DMN: Emphasize to clients that noticing thoughts is not "failing" at mindfulness but part of the practice. This reframes their experience of intrusive thoughts as expected and manageable.
• Mindfulness of Thoughts: Teach clients to observe thoughts as they arise, labeling them gently (e.g., "thinking," "remembering," or "worrying") without judgment. This reduces the tendency to suppress thoughts, which can backfire and increase rumination.
• Anchor to the Breath: After labeling a thought, gently guide the client to return their attention to the breath, reinforcing the concept of non-attachment to distractions.

2. Introduce Short, Flexible Practices

• Clients with ADHD often struggle with sustained attention, so recommend brief mindfulness sessions (e.g., 1–5 minutes) to start. Gradually extend the duration as they build comfort and tolerance for the practice.

3. Normalize and Celebrate "Noticing"

• Highlight that the essence of mindfulness is noticing. For clients with ADHD, noticing distractions or the activity of the DMN is a sign of progress rather than failure. This helps build self-compassion and reduces frustration with the practice.

4. Provide Structured Guidance

• Use guided meditations or specific instructions that offer frequent reminders to return to the breath or observe thoughts. ADHD clients often benefit from external structure to keep them engaged.

5. Use Visualization or Metaphors

• Introduce metaphors to help clients relate to their thoughts:
  • Clouds in the sky: Thoughts come and go, just like clouds passing by.
  • Leaves on a stream: Thoughts can be imagined floating by on a gentle stream.
  • Trains passing through a station: One can observe trains (thoughts) without boarding them.

6. Incorporate Movement-Based Mindfulness

• For clients who find stillness difficult, mindfulness can be practiced through movement (e.g., walking meditation, yoga, or even mindful stretching). This can help channel restless energy while engaging in the practice.
• Mindfulness Methods and Metaphors 
  
  
  

7. Integrate the ADHD Experience

• Validate the client’s experience of mental restlessness as part of their ADHD. Encourage curiosity about how their mind moves and how mindfulness might create space between stimulus and reaction.

Example Instructions:

1. "Let’s start with focusing on the breath. Just notice the sensation of air entering and leaving your nostrils or the rise and fall of your chest. There’s no need to control it—just observe."
2. "If a thought arises, that’s completely okay. You might silently label it—‘thinking’ or ‘planning’—and then gently guide your attention back to the breath."
3. "Imagine your thoughts are like leaves on a stream, floating by. You don’t have to pick them up—just let them drift as you return to your breath."
4. "If your attention drifts often, that’s perfectly normal. Each time you notice and return to your breath, you’re strengthening your ability to focus. That’s the practice."

This approach aligns with an understanding of the DMN in ADHD and creates a mindfulness practice that is compassionate, flexible, and tailored to their neurodivergent experience.

 Yes, stimulants used to treat ADHD, such as methylphenidate (e.g., Ritalin, Concerta) and amphetamines (e.g., Adderall, Vyvanse), can raise blood pressure and heart rate in some individuals. This effect is usually mild for most people, but it can be more significant for those who already have high blood pressure, a history of cardiovascular issues, or other risk factors.

 Key Points:

- Increase in Blood Pressure: Stimulants may raise systolic and diastolic blood pressure by a few points. For example, an increase of about 2-4 mm Hg in blood pressure is common.

- Increase in Heart Rate: They can also increase heart rate by about 3-6 beats per minute.

- Monitoring: Healthcare providers typically monitor blood pressure and heart rate before starting and during treatment with stimulants, especially in individuals with preexisting cardiovascular concerns.

 Alternatives:

If stimulants significantly raise blood pressure or are contraindicated, non-stimulant ADHD medications such as atomoxetine (Strattera), guanfacine (Intuniv), or clonidine (Kapvay) may be used. These medications often have a more neutral or even lowering effect on blood pressure.

If you're considering or are on stimulant medication and have concerns about blood pressure, regular monitoring and discussing adjustments with your prescribing doctor is essential.

See also: Rejection Sensitive Dysphoria (RSD): Symptoms & Treatment

Rejection Sensitive Dysphoria (RSD) is an intense emotional reaction to perceived or actual rejection, criticism, or failure. The term is often associated with individuals who have Attention-Deficit/Hyperactivity Disorder (ADHD) but is not exclusive to them. It's a neurological response rather than a psychological or emotional weakness.

 Key Features of RSD

1. Heightened Emotional Sensitivity: Individuals experience overwhelming feelings of shame, humiliation, or worthlessness, often disproportionate to the event.

2. Reaction to Perceived or Real Rejection: Even minor criticisms, teasing, or perceived lack of approval can trigger intense emotional pain.

3. Physical and Emotional Impact:

   - Feelings of deep sadness, anger, or rage.

   - Physical symptoms like chest tightness, nausea, or headaches.

   - Sometimes leads to social withdrawal to avoid potential rejection.

4. Brief but Intense Episodes: RSD episodes are usually short-lived but feel unbearable in the moment.

5. Impact on Relationships and Self-Image: RSD can lead to difficulty maintaining relationships, avoidance of situations where rejection might occur, or even perfectionism to prevent failure or criticism.

 Why Does RSD Occur?

RSD is thought to result from a neurological difference in how the brain processes social cues and feedback. Individuals with ADHD often have a heightened sensitivity to external stimuli, including social feedback, which may contribute to the intense emotional reactions.

 How RSD Differs from Other Emotional Responses

- Distinct from Mood Disorders: The emotional pain of RSD is situational and specific to rejection or criticism, unlike mood disorders that involve pervasive sadness or anxiety.

- Not the Same as General Sensitivity: While some people are naturally sensitive to rejection, RSD involves a much more intense and disabling reaction.

 Managing RSD

1. Self-Awareness: Recognizing RSD triggers and understanding the nature of the reactions can help manage the response.

2. Coping Strategies:

   - Mindfulness and Emotional Regulation: Techniques to calm the nervous system.

   - Reframing Thoughts: Challenging automatic negative beliefs about oneself.

   - Self-Compassion: Practicing kindness toward oneself when rejection feels overwhelming.

3. Professional Support:

   - Therapy: Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) can help address thought patterns and emotional responses.

   - Medication: In some cases, medications like alpha agonists (e.g., guanfacine, clonidine) or stimulants may help manage ADHD symptoms, reducing RSD's impact.

4. Building Resilience: Strengthening self-esteem and developing supportive relationships can help buffer against the intensity of RSD episodes.

If you suspect that RSD might be affecting you or someone you know, working with a mental health professional familiar with ADHD and emotional sensitivity can provide tools for better managing its impact.