When Christa Lei As they struggle to fit into societal gender boxes, they find an unexpected ally in their neurodivergent brains.

The 32-year-old Brooklyn-based writer grew up in Hawaii as the youngest child of Filipino immigrants. At age 17, they were diagnosed Attention Deficit Hyperactivity Disorder (ADHD)— a developmental disorder that can lead to inattention, hyperactivity and impulsivity — just before senior year of high school. A decade passed before they understood their gender identity, although they say the years spent living with and understanding their ADHD gave them the tools to explore life outside the gender binary .

“The breadth of human experience is so vast that it simply cannot be summed up in small sentences,” Lei said, reflecting on their journey. “Life is so beautiful and so vast that it is difficult for me to imagine putting myself in a small, confined box.”

Although researchers have not found a direct cause-and-effect relationship between ADHD and gender diversity, a 2022 article in Psychology Center It turns out that people with ADHD may question their gender or experience dysphoria more often than those without it. In a 2014 study on gender variance among people living with autism spectrum disorder (ASD) and ADHD, participants with ADHD were nearly seven times more likely to express gender variance.

Recent studies also reveal higher rates of ADHD in LGBTQ+ people compared to the general population:

• 2021 study in Psychiatry research found that LGBTQ+ adults are three times more likely to be diagnosed with ADHD
• Gender diverse youth are 6.6 times more likely to express gender variance if they have ADHD
• Among transgender and gender diverse people, 75% of people diagnosed suffer from gender dysphoria have ADHD
• Between 2006 and 2014, a report found that trans and non-binary youth suffered three to 13 times more mental health problems than their cisgender counterparts. majority of them ADHD and depression

John F. Strangneuropsychologist and director of the Gender and Autism Program at Children’s National Hospital in Washington, D.C., explained the connection in a press release.

“In ADHD, difficulties inhibiting impulses are at the heart of the disorder and could lead to difficulty keeping gender impulses “secret” despite internal and external pressures against cross-gender expression. » he said.

Strang noted that neurodivergent children and adolescents may be less aware of social restrictions against expressions of gender variance, making them less likely to avoid expressing these inclinations. “One might also hypothesize that excessively rigid or ‘black and white’ thinking might lead such a child to rigidly interpret mild or moderate gender-nonconforming inclinations as more intense or absolute,” he said. -he added.

Given the nature of Lei’s ADHD and their need to rely on creative ways to find personal structures that work for them, they view these two intersecting identities not only with curiosity, but also with humor.

“With ADHD, the mind is already (intrinsically) queer,” they said.

The increased prevalence of studies on gender nonconformity and ADHD

Teddy G. Goetzresident in non-binary psychiatry at University of Pennsylvania and affiliated with Eidos LGBTQ+ Health Initiative, in Philadelphia, published a study earlier this year with neurodivergence and gender variance specialist Noah Adams.

Their study, “The link between transgender, gender diverse people and attention deficit hyperactivity disorder: a systematic review” challenged the definition gap that often occurs in discussions of gender diversity and neurodivergence. Since 2014, researchers have published 17 papers on the link between trans and non-binary and ADHD, but the main problem they found is that authorship of authors from this crossover community remains missing.

Emotional regulation is another important piece of the puzzle, according to Kate Osburnauthor, speaker, educator, and content creator specializing in the intersections of neurodivergence, sex, intimacy, and communication. On TikTok, Osburn, who uses both “she” and “they” pronouns, harvested over 1.6 million followers with over 50 million likes.

Osburn said Count that ADHD can lead to heightened emotions, making emotional management more difficult. Combined with stress or anxiety related to societal pressures around gender norms, the feeling of being an outsider can be overwhelming, harming self-esteem and self-confidence.

“If you suffer from forgetfulness or impulsivity because of ADHD, and then face stigma for expressing your true gender identity, this could amplify feelings of self-doubt or inadequacy, especially when combined with common ADHD issues like rejection sensitivity, people-pleasing, perfectionism, and guilt or shame,” said Osburn, who identifies outside of the gender binary.

How the gendered approach to ADHD diagnoses neglects non-binary people

According to Osburn, even gender-affirming means of expression, like linking or folding, can be difficult for people with ADHD. Because sensitivity to textures, temperature, or tight clothing can overwhelm the senses, it can conflict with common methods of gender expression. This makes it even more difficult to find what feels “right” for a gender non-conforming neurodivergent person.

Medical means of diagnosing ADHD are deeply rooted in the gender binary.

A 2020 report, “Gender differences in adult ADHD” found that males had higher scores on the symptom scale during childhood. Children and adults with attention-deficit/hyperactivity disorder (CHADD)found that a gender gap leaves women undiagnosed when it comes to rapid diagnosis. They argue that women – presumably cisgender – suffer for a long time from untreated ADHD, while men – also presumably cisgender – tend to receive diagnosis and treatment earlier.

Osburn’s ADHD diagnosis arose from a gender medical problem: an ovarian torsion and ablation that led to such a rapid change in Osburn’s hormones that ADHD medical professionals missed Osburn’s entire life suddenly became evident. Although healthcare providers are often not trained to lead conversations with nonbinary patients, Osburn sees the importance of nuance.

Osburn emphasized that those who are female assigned at birth (AFAB) experience more hyperactivity and impulsivity internally, while those male assigned at birth (AMAB) experience hyperactivity and impulsivity as external behavioral difficulties, particularly in childhood.

“If a transmasculine student is struggling in school, their ADHD may not look like that of their AMAB peers, but that doesn’t make their experience any less valid or important,” Osburn said. People with ADHD who also menstruate are much more likely to experience premenstrual dysphoric disorder (PMDD), depression, anxiety, chronic pain, higher rates of eating disorders, self-harm and of difficulty orgasming, Osburn explained.

“A menstruating person’s hormonal cycle massively and dramatically affects not only the severity of ADHD symptoms, but also the effectiveness of medications. ADHD people with a penis are more likely to suffer from emotional dysregulation, substance use disorders, erectile problems and even car accidents.

A more acute awareness of being perceived

Jireh Deng it takes “a really, really long time” to get ready before leaving the house. Deng, non-binary journalist and editor at The Los Angeles Times tell Count that it takes considerable effort to think deeply about how they present their gender in the corporate environment — an effort that is difficult to code as someone diagnosed with ADHD during the pandemic.

“I hate being caught off guard when I’m out, seen by men (while) I’m wearing more feminine attire, and it feels like my insides are being ripped out,” said Deng, who finds it more painful to being misgendered by men than by men. women. “I think part of it is the implication of where I occupy space in heteropatriarchy; men, more than women, have been allowed to touch or grab me in public spaces, and I think my intense aversion to being noticed or my anxiety about it is related to my ADHD.

As the child of immigrants from Taiwan and Hong Kong, Deng feels an added pressure: the unique expectation of gender roles that they must fulfill as an excellent student, even though their brother had just as many challenges. difficulties and was supported to obtain medication. For Deng, expectations were compounded by gender and sexuality.

“Historically, my parents didn’t talk about my ADHD or my queerness or my gender because I did well in school, and I think for a long time I hoped that the queer part of me would disappear and I would eventually return to factory settings. »

Embracing Deng’s non-binary and ADHD identities felt like a journey from self-acceptance to finding ways to ground himself. These days, they allow themselves to take a step back when they feel overwhelmed and overstimulated by stepping away from their phones and electronic devices and going surfing on the weekend.

“It’s really important to honor your feelings and show yourself as authentic as possible,” said Deng, who has since stopped hiding, developed self-confidence and self-acceptance, and is happier. “I truly believe that accommodations are not just an option but a necessity.”

Lei believes that being non-binary and having ADHD encouraged them to remain emotionally open. Despite the lack of research or answers in this intersection of experiences, embracing the unknown and remaining curious is essential.

“People are so rigid. Stay curious, because only you will know what works for you.