I’m late in acknowledging it, but October is ADHD Awareness Month. My client base and caseload have always seemed to lean neurodivergent, and with the suggestion of a trusted colleague, my curiosity about my own wiring hit critical mass in the last couple of months. As it turns out, I don’t just have clinical experience. I have lived experience, and the more people I tell, the more I’m realizing that everyone else knew all along. 

Can we talk about neuropsych testing? That sh!t was stressful. To state the obvious for anyone who’s ever been in therapy or gone to the doctor’s office or done any kind of eval, it’s vulnerable and sometimes scary to be so closely examined… and still wonder if you’re going to be genuinely seen, understood, and effectively helped. AND, those evals can have a high false negative rate because they don’t necessarily capture real world executive functioning. The tests are novel, time limited, and otherwise highly structured, which is an environment ripe with the potential to mask– either accidentally or intentionally. At least one ADHD specialist that I've learned from advises against the full battery of testing when assessing for ADHD in favor of a more personalized approach with a well-informed clinician. Either way, people’s own self-awareness and self-advocacy are critical to help paint a clear picture. Even as a clinician who has studied neurodivergence in relative depth, I still came face to face with my own cognitive dissonance, wondering if I was overselling my legitimate experiences that rationally I KNEW were relevant to assess for an accurate diagnosis. My point here is that if you’re thinking about getting tested, it makes sense that you might be a little apprehensive. I encourage you to remember that while your evaluator is the expert on high level criteria, you are the expert on your experiences. Read articles and books, listen to podcasts, get informed where you can, and if you think your experience might be relevant, share it. You bring the ingredients; it’s the evaluator’s job to figure out what they make. Diagnosing mental health conditions can be tricky business – it’s not like, yup-that’s-a-broken-bone – and it can’t be accurate without your input and collaboration. 

Don’t get me wrong. As stressful as the testing was, it was also interesting. Something I have known for a long time is that learning about the way we humans tick is definitely a special interest.

In the wake of my diagnosis, I’ve been reflecting on not just my life experiences and what I nerd out on in a new light, but also on how I work, including explicitly acknowledging ADHD as a focus in my practice, and exploring more deliberately and in depth how it intersects with sex therapy. This is a pretty niche domain, as research connecting sex and ADHD is in its relative infancy compared to other more robustly studied areas, but we’ve got some great starter information. While I have a rough gazillion tabs open on my computer, I’m just going to sum a few things up for you with some brief quotes, resources, and some initial guidance. If I try to consume and synthesize all the resources I’m swimming in right now, this post woud be way too scattered. Actually, it would never get written.

So here we go: 

• "Core difficulties related to ADHD, including inattention, distractibility, and emotion dysregulation, may make individuals more vulnerable to experiencing problems with sexual function and sexual distress, putting them at risk for developing sexual dysfunction." ~ Goldberg et al

• "People with ADHD have the same difficulties with sex as people without ADHD, but perhaps more often or more intensely. I call this the ADHD multiplier: the ADHD multiplies the difficulties but doesn't really create unique problems that others aren't also experiencing. Many of the sexual problems for these folks isn't about sex per se, but about the relationship struggles that undermine a satisfying sex life." ~ Ari Tuckman, author of ADHD After Dark: Better Sex Life, Better Relationship

• “Rather than viewing ADHD as a disorder to be corrected, this perspective emphasizes the importance of environmental fit, affirming that neurodivergent functioning can thrive in contexts that are stimulating, structured, and consensually co-regulated.” ~ Dr. Leann Borneman

• “women diagnosed with ADHD (exhibit) a pressing need for increased structure in the sexual encounters.... as well as a necessity to deconstruct existing scripts and narratives surrounding spontaneous desire and other neurotypical norms associated with intimacy.” ~ Dr. Leann Borneman

• Sex & Psychology Podcast episodes 416 and 417 interview Dr. Borneman about her exploratory research at the intersection of ADHD, women, and BDSM.

If any of this has resonated with you so far, something I hope you'll take away from this post is an awareness that if ADHD is getting in the way of pleasure, connection, or feeling good about yourself, there’s support out there. You don’t have to white-knuckle things. If thoughts and experiences about sex stir up discomfort, if you and your partner are at an impasse, or if sexual behavior or porn use feels out of control you can reach out to me (I’m licensed in Texas and Oregon) or you can take a look at the AASECT directory to find other qualified professionals. 

In the meantime, the goal isn't to force yourself to fit into a sociocultural default setting (neurotypical, sexual, or other). It's to cultivate a life with pleasure and connection that fits your identity, your values, and the strengths, limitations, and the relational systems you live in. Here are some ideas: 

• Start by acknowledging the role ADHD might be playing for you; name it. If you’re not sure, get curious (see resource links above). 

• Reflect on your own behavior and fantasies, self-assessing for alignment with the 6 Principles of Sexual Health. 

• If you and your partner(s) seem to be missing or avoiding each other, schedule some time to get intimate. Notice I said intimate, and that word is not being used as a euphemism right now; intimacy takes many forms. Pressure, demand, or entitlement can kill desire and arousal faster than any ADHD symptom because they rob people of their agency and because they turn sex into another obligation on the to-do list. Sensory distractions and fatigue pass, but feeling obligated can linger in the form of resentment or avoidance. So, schedule an experience that has the potential to land you next door to the sexy room. We’re looking for collaborative inspiration and invitation, not a mandate. Planned intimacy isn't unromantic; it's how busy adults can make sure it happens at all, and you can use anticipation to your advantage– flirt with each other! Remember your early weeks, months, and maybe even years? My guess is you were probably very intentional about your grooming, your outfit, your behavior, your activity, and the undies you chose when you were planning to see your special person. It might (probably will) look different in different seasons of your life and relationship, but you can be just as deliberate.

• Try something novel. New locations, toys, roles, or simply a different time of day can help keep you engaged, and it doesn't need to be extreme to work.

• But I think I probably put the proverbial cart ahead of the horse there. Novelty can start with just talking openly about sex with curiosity, vulnerability, and non-judgement. It’s harder than it sounds. Click this link for a book that might help, and no, you do not have to be kinky to read it. 

• When desire doesn't match, explore for where things do line up. Connection counts, and see the bullet point about communication above. Being able to communicate and collaborate is critical to keeping the connection alive, even when you might not be sure about what erotic compatibility can look like; it might be more expansive than you imagine. 

• To minimize distractions and pave the way to that sexy room door, engineer your environment and cultivate an inviting context. That means put your phones in another room, get mindful and deliberate about lighting, temperature, music, or any other element that would hit the brakes if left or the accelerator if added. If you haven’t heard about brakes and accelerators, here’s a link to another Emily Nagoski resource, Come As You Are. 

• When your mind wanders (because it will), guide it back to these sensations when you catch it: pressure, temperature, texture. This little mindfulness exercise to get you back in your body and in the moment is straight out of Masters & Johnson’s broader Sensate Focus model, which is a whole process for reconnecting with your partner(s), and I’d argue with yourself also. To my surprise, and I’d be happy to be corrected, I couldn’t find any scholarly literature at the ADHD/Sensate Focus intersection to empirically validate its use, but it’s not uncommon for therapists to adapt established models to client experiences. This Australian practice blog post touches a bit on some of those adaptations. There is also other literature out there to help ADHDers with sex and relationships, including Tuckman’s work (so far I’ve only read ADHD After Dark and some articles) and this book (which I haven’t read yet but I have added to my queue).

• Pay attention to the division of labor and mental load in your relationship. I know. It doesn’t seem sexy, but I swear to you it is. Taking reliable initiative to share the load is one of the most powerful aphrodisiacs there is, especially in combination with effective and open, vulnerable communication. Just like I emphasized intimacy as not necessarily sexual, I’m emphasizing reliable initiative here because teamwork is not transactional. You do not get head for cleaning the kitchen and folding the laundry. What you might get is a collaborative relationship where everyone feels seen, appreciated, and supported rather than taken for granted, and that is what has the potential to unlock more sexy time.

• But chores suck, and my ADHD symptoms are a barrier to focus, task initiation, and completion! Fair point. How do we balance the labor and load if one, the other, both, or all partners have impaired executive functioning? This takes us back up to that very first bullet point: acknowledge and own your ADHD, not as a justification for doing less, but as a key aspect of tayloring strategies to personal and relational values and goals. If resentment, entitlement, and/or feeling unappreciated feel unshakeable, you might need some additional support and guidance. 

Welp… I just wrote more than anticipated. If you made it to the end, thank you, and if you skimmed, skipped around, or just read the first few words of the bullet points, the gratitude remains the same. I guess you can consider this post its own mini case study in ADHD: what was originally intended as a quick social media note about ADHD Awareness Month turned into so much more. My hope is that something here helped you feel a little more understood, or a little more curious about yourself, your partner, or the space between you. October is wrapping up, and while you may or may not be neurospicy, the invitation stands year-round for you to get curious, find your truth, and remember that pleasure and connection are integral to quality of life, and they take so many more forms than most of us are taught to imagine. If you want some support figuring out what it can look like for you, I’m here and happy to connect or help you get connected to other professionals.